Foot Surgery Post-Operative Care

///Foot Surgery Post-Operative Care
Foot Surgery Post-Operative Care2017-01-29T08:00:33+00:00

The following are post-operative instructions for patients who have undergone foot or ankle surgery. The procedure is performed on an outpatient basis (discharged same day after surgery). You will require someone to assist you getting home and for the night of surgery.

Incision care

The sutures utilized in closing any wounds are non absorbable and will need to be removed. Schedule an office appointment for about 10-14 days from your surgery so the wound can be checked. 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 we remove the dressings. Additional wound care instructions may be provided to you on discharge. Some swelling, bruising and warmth is expected after surgery. If you develop increased redness, drainage, or a fever, CALL THE OFFICE. Bruising around the area is not uncommon. This may even extend up the leg or down into the toes and will resolve in over 3-4 weeks.

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.

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 400-600 mg 3-4 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.

Swelling

Again, swelling around the ankle and down into the toes is NORMAL. I want you to elevate most of the time for the first couple weeks and avoid prolonged dependency of the foot. Reducing the swelling as much as possible will improve comfort and mobility. Pumping the toes, if they are not the surgical site, or pumping the ankle, if it was not the surgical site, can help with swelling. Sleeping with a pillow under the foot can reduce swelling and pain. Wear the TED stockings (white) on the non-operated site until you are up regularly, usually 1-2 weeks after surgery. Once you are up and about regularly you may discontinue the stockings.

Ice Therapy

An ice pack will be applied after surgery. The ice should be replaced every 2-3 hours for the first couple days. Protect the skin from direct contact with the ice pack. (Not necessary to change as often during sleep hours.) After the first few days apply a refreshed ice pack on the shoulder, 3 or 4 times a day for 20-30 minutes. The ice and elevation may be helpful up to 2 weeks after surgery. If you feel the swelling is excessive you should call the office.

Walking

Following many foot procedures, you could walk out of the hospital bearing fully on your operative leg with a postoperative hard sole shoe. Upon discharge from the hospital, you will be walking with the assistance of a walker or crutches. On your post op 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-weight bearing. Even if it states full weight bearing, we prefer that you unload the leg walking on the heel or using crutches temporarily. You may go up and down stairs as needed and physical therapy will help with some tricks until flexibility allows normal stairs.

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 cast bag). 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.

General Expectations

These are averages, remember that each case is individualized, depending on your general health, age, and attitude. For 3-4 weeks after surgery, your activity level is usually limited, however, you will be able to walk independently and use bathroom and kitchen facilities. Within 6 weeks you will have resumed more of your normal activities. During this initial 4-6 weeks time, some swelling and discomfort is normal and should be manageable with the prescribed medications. Most foot and ankle surgery is safe and performed as outpatient surgery, so postoperative complications are fortunately quite rare. Early problems usually involve swelling, infection issues would be approximately 5-7 days following surgery. They consist of a significant increase in pain, swelling, warmth, and redness of the extremity, fever, chills or night sweats. 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.

Important: If you then still have any questions or concerns please notify me, my nurse, or physician assistant.

Bryan Bomberg, MD
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