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Foot Surgery Post-Operative Care

The following are post-operative instructions for patients who have undergone foot or ankle surgery. Please refer to this reference sheet, which should probably answer most of the questions you might have. If you have further questions that need immediate answering, contact us at our office at (970) 879-4612 or 877-404-4612.
CRUTCHES:
Following many foot procedures, you could walk out of the hospital bearing fully on your operative leg with a postoperative hard sole shoe. On your postop directions the exact amount of weight bearing will be specified. Foot or ankle surgery with a cast usually involves a temporary cast or splint initially and will need to be completely non weightbearing. Even if it states full weight bearing we prefer that you unload the leg walking on the heel or using crutches temporarily. We feel you will be more comfortable, with less pain and swelling, if you utilize the crutches for a few days to lessen or avoid the weight bearing impact to your foot. You may obtain crutches with a returnable deposit from Lyons Drug, City Market or Safeway, order online, or physical therapy will fit you.
DRESSINGS:
You will have a bulky dressing over your foot or ankle. Although it is very unlikely, you may notice some bloody spotting coming through the outer Ace wrap or cast. It is important for you to watch this area, and contact us if it continues to spread. Otherwise, any small area of spotting will dry and can be ignored until you remove the dressings.
SUTURES:
The sutures utilized in closing any wounds are usually an nonabsorbable type, and will need to be removed unless you are told otherwise. They will usually be removed in 10-14 days unless the wound is not ready.
ICE:
Ice and elevation will help minimize the pain and swelling after surgery, especially during the first few days. Elevation, to be effective, involves keeping your foot and lower leg above the level of your heart. You can keep ice packs on the foot continually during the first few days without risk of frostbite injury to the underlying skin as long as the original dressings are in place. The initial post-operative wrap involves multiple layers of cotton gauze and padding, therefore insulating the skin surface reasonably well. Once we have removed the original dressing and applied only a light dressing we would recommend ice applications to the involved foot or ankle region for 20 minutes at a time, multiple times each day.
SHOWERS:
You must keep the dressing dry and can use the bath with the foot hung out of the tub or sponge bath. If you must use the shower you will need to apply a plastic bag around the foot and tape it at the top. There are excellent cast protector products available locally at pharmacies or online from Amazon (Duro-Med).  However, it is hard to keep the dressing absolutely dry and some leakage may occur. If the dressing gets a little wet allow it to dry.

PHYSICAL THERAPY:
Depending on the type of surgery you underwent you may be provided a prescription for formal physical therapy when you leave the hospital. If not then we may prescribe the exercises in our office or with the therapist at a later date when healing will allow. All of the different therapy firms in our area are excellent with foot and ankle rehabilitation, so you are free to select your therapist.
OFFICE FOLLOW-UP:
Please call our office within a few days following surgery to schedule your first follow-up visit for 7-10 days after surgery. This can vary plus or minus several days depending on your schedule and ours. Any exceptions to this will be noted in the discharge directions.
MEDICATIONS:
You will be provided with a prescription for a pain medication when you are ready to leave the hospital. Usually we will prescribe hydrocodone, hydromorphone, or oxycodone. These are generic names for three different narcotic pain relievers. If you are aware of a certain pain medication that you have previously had problems with, or one that you normally respond favorably to, please inform us so that we can give you the appropriate prescription. You may have the prescription prior to surgery to avoid filling it the day of surgery.
Normally we will avoid using anti-inflammatory medication (i.e. ibuprofen, Advil, Aleve, etc.) as this may interfere with bone or tendon healing. If you are intolerant to most pain medications the short term use of anti-inflammatory medication is OK.  In this case you might be given a prescription for an anti-inflammatory medication Toradol (ketorolac) that will help lessen pain and swelling. If not, you are welcome to use an over-the-counter anti-inflammatory such as Ibuprofen (Advil, Nuprin, etc.). These come in 200-mg tablets. The usual maximum adult prescription dosage is 600-800 mg three times per day, usually taken with food. This would amount to taking 9-12 store tabs per day. The anti-inflammatory medicine can be taken on a regular basis along with the prescription pain medication, which is utilized on an as needed basis. You will find that the combination will lessen your need for the prescription pain pill. If you have a history of ulcers or of stomach irritation with aspirin or anti-inflammatory drugs, then you should avoid taking these medications. If you have high blood pressure you should check your blood pressure to be sure these medications do not cause an elevation in your pressure.  If you have kidney problems you should avoid these medications.
Plain tylenol is OK if you have no liver disease. Remember, the short acting pain pills often have acetaminophen (Tylenol) in them. The maximum daily dose of Tylenol if you have a normal liver is 3500-4000 mg.  If your narcotic pain medicine is not lasting long enough you can use a little more or use if less often as long as you do not overuse the maximum daily acetaminophen dose.
If you have a history of nausea with surgery we can prescribe an anti-nausea medication (Phenergan or Zofran).  Try to take this medication regularly at first and prior to taking the narcotic pain pills to allow it to be most effective.
Please try to anticipate the need for any refills on your pain medication, and contact our office early in the day the day before running out completely. I cannot provide prescription refills after business hours or on weekends.

COMPLICATIONS:
Most foot and ankle surgery is a safe and performed as outpatient surgery, so postoperative complications are fortunately quite rare. The incidence of an infection is literally one out of thousands. Onset of symptoms would be approximately 5-7 days following surgery, and would consist of a significant increase in pain, swelling, warmth, and redness of the extremity, fever, chills or night sweats. More common, but still unusual, would be a small superficial infection or irritation at one of the skin incisions. There can also be a very small incidence of a blood clot developing deep within your arm veins or leg veins. If you have had a previous blood clot, use estrogen, or have a family history of blood clots in the legs, arms or lungs you should probably be protected with TED hose and a blood thinner.  If we did not start this let us know.  If we recommended aspirin for blood clot protection you should use a baby aspirin twice a day for 2 weeks or as long as the leg or arm is immobilized.  A blood clot would be characterized by a sudden onset of new pain (usually different from your surgical lower extremity pain) or tightness in the upper arm or more commonly the leg. This usually begins about 5-7 days from the day of surgery. The presence or absence of a clot can usually be determined by a simple non-invasive ultrasound test at the hospital. Contact our office for any concems at 970-879-4612 or 877-404-4612.  01/13