It is extremely important in the first two weeks following your operation to keep your foot dry and not get it wet. If contemplating a shower it is advisable to obtain a Limbo bag which forms a watertight seal around the limb and will prevent the affected foot or leg from getting wet. This is to minimise the risk of wound breakdown and infection.
To minimise pain, swelling and post operative complications such as wound breakdown and infection.
Surgery around the foot and ankle can result in massive soft tissue swelling. Unchecked this can result in pain, delayed healing and possible wound breakdown and subsequent infection. It can also delay the healing time and result in increased complications. It is important to minimise the swelling by keeping your foot elevated at the level of your heart. This can be done by making sure that you recline with pillows and cushions underneath the foot and ankle. It is advised to stay housebound for the first two weeks to allow for sufficient elevation. If you have previous or existing problems with your back or hip(s), elevate to just above your groin. Get up for five minutes out of every hour to do necessary tasks, for example, going to the toilet then ELEVATE your limb.
It will become obvious to you that when you stand up and put your foot down it will start to throb and hurt. Elevating the foot & ankle will alleviate the pain and discomfort post-operatively.
It is not unusual for some blood to ooze through the bandages, especially when you first get up and have your foot in a dependant position. Elevate the foot and the bleeding should stop.
If you have continued bleeding, please contact your surgeon. If you are unable to contact your surgeon please call the ward or contact your general practitioner. Keeping your foot elevated will help minimise this risk.
Surgery involves repairing a damaged area in your foot or ankle. Putting weight on an operated foot or ankle can do damage to the repair that has been done. Your surgeon Mr Malik will give you clear instructions regarding your weight bearing status following surgery, please DO NOT IGNORE this advice.
Your foot and ankle bear the whole body weight when walking and standing. This amounts to a substantial load and force across the foot. Surgical wounds heal better when they are not stressed by weight. Incisions such as those for an Achilles tendon repair or a fracture repair can particularly benefit from being non-weight bearing, but all procedures that involve surgical incisions need a period of non weight bearing so that the incision can heal.
The soft tissues (skin, fascia, joint capsules, tendons and muscles) need time to heal. The bones also need time to heal. Plates or screws that may have been added during surgery need the bones to heal around them. Joints that have been fused need time to heal. Adding weight too soon can interrupt this important internal healing process.
Keeping the foot non-weight bearing for a period after the surgery also helps reduce pain and swelling which is inevitable following any foot and ankle surgery. Minimising the swelling allows the tissues to heal quicker, minimises risks such as wound breakdown, infection and chronic swelling.
A post-operative anti-embolism stocking (provided by the ward) should be worn on the un-operated limb until you are fully mobile. This will help reduce the risk of blood clots following surgery.
Wriggling your toes, massaging your calves and regular movements of your lower limbs (as able) will help maintain healthy circulation during periods of reduced mobility.
It is also important to drink lots of water and remain well hydrated. If your foot and ankle are in any form of plaster cast, injections to thin your blood will be prescribed to help reduce the risk of clots.
Quite simply your body will tell you if you have overdone things. Your foot will hurt and throb, particularly at night or the day after.
It is important to remember that the foot can be very swollen for several weeks following your operation and this is normal. However, if you notice that the foot is becoming increasingly swollen following this period, it may be an indication that you have overdone it.
The remedy is to rest, ice and elevate your foot/feet as this will help to reduce painful swelling and improve circulation, thus promoting wound healing and aiding in recovery. Use pain and swelling as a guide to how much you can and cannot do.
If you have undergone surgery for a foot and ankle condition a simple way of knowing when you are safe to drive is testing if you can stamp your feet firmly on the ground. For example, would you be able to do an emergency stop? If you can do this without any hesitation or pain, then you are generally felt to be fit to drive. Patients who have surgery on their left foot and drive automatic cars can potentially return to driving sooner than those with manual cars. It is ultimately the responsibility of the driver to assess whether they are fit to drive and to contact their insurer.
The DVLA has issued guidance regarding driving after surgery. The following is a paragraph from “For Medical Practitioners, at-a-glance guide to the current medical standards of fitness to drive” issued by the Drivers Medical Group, DVLA, Swansea 2013 edition.
“Drivers do not need to notify DVLA unless the medical condition is likely to affect safe driving persists for longer than three months. After the surgery (but please see neurological and cardiovascular disorders sections for exceptions) therefore, license holders wishing to drive after surgery should establish with their own doctors when it is safe to do so. Any decisions regarding returning to driving must take into account several issues. These include recovery from the surgical procedure, recovery from anaesthesia, the distracting effect of pain, impairment due to analgesia (sedation and cognitive impairment), as well as any physical restrictions due to the surgery, underlying condition, or other co-morbid conditions. It is the responsibility of the driver to ensure that he/she is in control of the vehicle at all times and to be able to demonstrate this is so, if stopped by the police. Drivers should check their insurance policy before returning to driving after surgery.”
For any additional advice contact your surgeon, Mr Malik.
Smoking has a significant negative impact on wound and bone healing and will result in increased risk of post operative complications such as wound breakdown, infection and non union (when the bone fails to heal).
To ensure a low risk of complication and improved outcomes please stop smoking before your operation and for the duration of your recovery and rehabilitation.
Under the specific foot and ankle condition, you will find details of surgery and the post-operative recovery. General guidelines have been given regarding specific return to full function. However it is important to realise that every individual heals differently and some patients will heal faster than others.
Patients are always surprised at how long it takes to recover from even the most minor of procedures. This should be borne in mind before deciding to go ahead with surgery. If you have important commitments, holidays booked a few months in advance or need to travel then you may wish to defer any treatment or cancel your plans. Again it is important to discuss with your surgeon for further guidance prior to any surgery.
Surgery to the foot and ankle can be quite debilitating for a few weeks, affecting your mobility and independence. Some operations require you to be house bound with high elevation of the foot for 95% of the time for the first 2 weeks post-operatively and then elevated for 75% of the time for the next 4 weeks. For major surgery it may be several weeks if not a few months before you can drive especially if it is your right foot that has been operated on. It is important to consider the following:
Healing rates are affected by multiple factors such as age, blood supply, medical co-morbidities, smoking, diet, the underlying injury, the operation itself and compliance with the post-operative regime to name a few examples.
As a rough guide to healing following foot and ankle surgery, you should expect 3 months of some discomfort and swelling. On average it is usually 12 months before you can truly appreciate the results of surgery and regain the feeling of normality and full function.
Most patients are quite surprised at how long it can take for swelling to settle and for them to be able to return to their normal shoes, even after minor surgery. The majority of patients following foot surgery will be given a post-operative stiff-soled shoe. You will be required to wear this for approximately six weeks.
After this point it is important to wear stiff-soled shoes before gradually weaning on to normal shoes, as this prevents excessive motion of the joints in the foot. Minimising movement will minimise pain. It is also important to wear wider-fitting shoes, as these will also accommodate any swelling.
This depends on individual patient factors, the underlying foot & ankle condition, the treatment undertaken, the nature of the job and the commute to work.
Operations vary considerably and it may take longer to return to work if you have a more manual and physical job than one that is sedentary. Patients with a long and difficult commute to work may also find that it takes longer to return to work than those that do not. Please speak to your surgeon Mr Malik for further guidance.
This again depends on the underlying condition and the surgery that has been carried out. Please speak to your surgeon, Mr Malik and your physiotherapist for guidance regarding return to sports.
It is important to contact your airline and inform them of your planned surgery. It is also important to notify them of your post-operative recovery and whether you have been immobilised in a plaster cast or Aircast boot. Each airline has different policies and guidelines.
One of the main risks following surgery is that of a deep venous thrombosis (blood clot in the leg). The risk is higher if you fly soon after surgery. Further risk factors include pregnancy, obesity, family history of blood clots, previous history of blood clots, travelling for long distances with restricted leg movements, immobility, smoking, age over 60 and if you are on a contraceptive pill which contains oestrogen or hormone replacement therapy (HRT) or cancer.
It is also generally not advisable to fly soon after surgery as this can cause significant swelling of your foot and ankle, which will already be swollen following your operation. This can impair wound healing and result in stiffness in your joints.
If it is absolutely necessary to fly soon after surgery, it is advisable to take some medication to reduce the risk of blood clot formation and you should discuss this with your surgeon.
Modern foot and ankle surgery is safe and clinically effective in the vast majority of cases. However no surgery is without complication, and no surgeon has zero complications. Surgery should only be considered after all conservative treatment options have been exhausted or unless there is no alternative but surgery.
A famous American orthopaedic foot and ankle surgeon, Professor Charles Saltzman tells all his patients, “There is no condition an operation cannot theoretically make worse”. This is important to remember, and while complications are rare and usually not serious, there is always a risk that an operation will not work, make your symptoms worse or result in new symptoms.
Fortunately the majority of complications are not serious and easily treatable with delay in recovery the only outcome. By adhering strictly to the post-operative guidelines and rehabilitation regime one can minimise the risk of complications and poor surgical outcome.
See Foot & Ankle conditions for specific complications related to non operative and operative management for each individual disease and condition.
See Complications for details regarding generic complications associated with most if not all surgical procedures.
Orthopaedic Outpatient Department
30 Devonshire Street, London, W1G 6PU
tel: +44 (0) 203 7956053
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