There are a number of ways that post-operative pain can be managed. You will likely need to use a combination of the following strategies:
Post-Operative Nerve Blocks
Many anesthesiologist or surgeons will perform local (nerves around the operative site) or peripheral (nerves leading to the operative site) nerve blocks. This is similar to what the dentist does when fixing a cavity. It can leave your foot numb in the short term after surgery. However, it can be very helpful in the hours immediately after surgery and can really minimize the amount fo pain medication that is required immediately after surgery. Depending on the type of “nerve block” the local freezing may last from 3 hours to 15 hours (or longer)
Narcotic Pain Medication
Narcotic pain medication is often prescribed after surgery. It can be very helpful at managing pain but does have side effects. There are many different types of narcotic pain medication (ex. Vicoden, Percocet, Norco, Tylenol #3). Most are short acting and will last for 4-6 hours therefore they need to be taken regularly to achieve their effect. It is important that you take enough pain medication to stay ahead of severe pain. Some pain medications (ex. Oxycontin) are long acting and therefore only need to be taken 2-3 times per day. Side effects of pain medication can include: nausea and vomiting, confusion (or feeling “weird”), constipation, and the potential for addiction.
Anti-Inflammatory Pain Medication (NSAIDs)
Anti-inflammatory medication (ex. Ibuprofen, Advil, Motrin, Aleve, Voltaren, etc.) can be a helpful additional means of managing post-operative foot pain. However, anti-inflammatory medications may have an adverse effect on bone, tendon, and ligament healing so consult your doctor before taking anti-inflammatory medications regularly to help manage your post-operative pain. In addition NSAIDs can have significant side effects such as stomach irritation, ulcers, or bleeding; or kidney problems.
Keeping your foot elevated 6-18 inches above your heart can be very helpful at minimizing swelling and therefore decreasing post-operative pain. The best way to elevate your foot in this way is to lie on abed or sofa with one or two pillows under the foot.
It is critical to avoid activities that will require you to have your foot dangling down for any significant period of time in the early post-operative period. Therefore avoid shopping excursions or other activities where you will be standing for any length of time in the first few weeks after surgery.
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Ice placed in a plastic bag or a package of frozen vegetables can be very helpful at controlling post-operative pain. Ice should be applied for 10-15 minutes at a time and then removed for 10-15 minutes. Ice should NEVER be used when the foot is numb from a nerve block as this can easily lead to frostbite. If a cast or a thick dressing is in place this may diminish the effect of the ice as less cooling will get to the operated area. Ice works in part by constricting the small blood vessels around the foot and ankle and thereby decreasing the blood flow to the area. There are commercially available ice pumps that can be helpful, but should again NEVER be used if the foot or ankle is numb.