Foot surgery pre-op suggestions
You are about to have foot surgery. It may sometimes be difficult to grasp all of the facts about this procedure so we are attempting to give you general guidelines to help you on the road to good health and good walking. As all operations differ it is important that you ask specific questions about anticipated recovery times for your specific surgery.
Prior to surgery
Before the surgery you need to prepare to be out of work from 3 weeks to 6 months, (depending upon the level of physical exertion needed in your work and the type of surgery you are having). Your Physician will discuss a realistic time frame. You may be inclined to discount the information, as it is often difficult to anticipate the reasons to be out of work. Most people tend to underestimate the time associated with recovering from foot surgery.
Proactively prepare for the recovery period
Try and think about all of the things you are likely to need in the recovery period. Some things to do:
- Stock up on supplies (food etc.) so you do not need to leave the house often.
- Enlist the help of your family and friends.
- Get some books and movies to occupy your time in the recovery period
- Prepare your house. Move objects that will make it difficult to move from one room to another. Consider moving your bed to the ground floor. Prepare your bathroom and shower area (shower stool, grab bars, etc.)
Create a “command post”
You will be most comfortable if you have a bed “command post” with supplies that you can readily reach. Suggested supplies are:
- Computer (if you use one) include email addresses, computer movies (best to have someone get them for you or have mail order or downloadable)
- Hospital-type table that slides over the bed or couch may be helpful
- A Foot elevation system of some kind (ex pillows)
- Bed backrest
- Writing materials (ex. pencil, paper, (to keep track of medications))
- Drinking supplies,
- Metamucil or Colace as bowel activity is limited by pain medications.
- Hand lotion
- Any handiwork that you might be interested in (don’t expect to have the mental ability to take up a new hobby).
- Driving (DMV) – Obtaining a Temporary Handicap Placard: You should consider arranging for a Temporary Handicap placard during your recovery period. In most states this requires your physician to complete Temporary Disabled Parking Permit. Many surgeons will have these forms in their office. If they do not you can usually download a form from the States DMV website. You may be charged a small fee to have this form completed. Once completed the form can be mailed to the DMV and it takes a few weeks to be processed. Alternatively, you can make an appointment or walk into any DMV office with the form and they will issue the placard. You should consider doing this prior to surgery as standing in line with crutches while your leg is dangling down shortly after surgery can be problematic
After surgery you will have swelling in the foot, and pain from the incision. The swelling is related to the increased blood flow to the foot in response to the “surgical injury” as well as the decreased capacity of blood to return to the heart due to less muscle lower leg muscle contractions (which have the effect of increasing venous blood return). Swelling is often directly proportional to pain. The greatest swelling occurs in the first 3-4 days after surgery. After that the swelling gradually diminishes. However, it often takes many months (or even a year for major surgery) for all of the swelling to resolve. The pain associated with swelling can vary widely. If it is not managed appropriately it can be very uncomfortable and frustrating.
Post-operative pain control
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.
- Foot Elevation: 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.
- Activity modification: 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.
- Ice: 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.
- Work: Be prepared to spend the first one to four weeks lying in bed or on the sofa with your foot elevated. Your primary “work” during this time will be to facilitate foot healing. The first few days you will likely find it too painful to put any weight on any part of your foot so will need to be waited upon, or you will need to use crutches and/or a walker, or if your arms are weak a “knee walker”, wheelchair, or scooter. You should not return to work until you believe you can function at an acceptable level. This will depend on the type of surgery you had, as well as the type of job you have. Remember that when you are taking pain medications your thinking ability may not be 100%. Consider avoiding work conversations and serious emails while you are on regular narcotic pain medications. It may be necessary for your surgeon to write a note outline how long you need to be off work.
- Showering: Showering can be a challenge following surgery on the foot or ankle. It is important to shower in a manner that optimizes safety. Falls in the shower during the post-operative period are surprisingly common and can lead to damage to the surgical area or injury to a different area of the body.
When showering you should sit on a shower stool. A shower stool that is made of plastic or wood will usually tolerate water from a shower. Commercially available shower stools or benches can be purchased and may have some advantages over a regular chair. A human assistant can be very helpful especially getting in and out of the shower. It will be helpful to place grab bars in appropriate locations on the shower. These can be obtained at many hardware and bathroom supply stores.You will need a waterproof container to cover your foot and lower leg when showering. This can be achieved by placing a plastic garbage bag over your foot up to the level of the knee. Alternatively you can purchase a commercially available “cast protector” which may be easier and more effective to use. If you do get a cast wet it may be necessary to change the whole cast as getting the cast lining wet is similar to wearing a wet sock around. It is not at all good for the skin, or for wound healing.