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. Complications will be discussed in the After your operation section.
Foot and ankle surgery is undertaken to alleviate pain and improve function. It should never be considered for cosmetic purposes.
After weighing up the potential benefits and drawbacks of surgery, you alone need to decide whether your symptoms warrant any surgical intervention.
Patients with conditions affecting both feet routinely ask if they can have surgery to both feet at the same time. While this would seem to make sense from a convenience point of view many other factors have to be considered and certainly the risk of complications can be higher if you do not have a “good” foot to walk on. It is important to remember that no two patients are the same and that individual patient factors have to be considered. Your surgeon will give more advice and guidance on this.
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 postoperatively 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, and the operation itself and compliance with the post-operative regime to name a few examples.
As a rough guide of 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.
Most patients will be asked to attend a Pre-operative Assessment Clinic in advance of their operation. This may be face to face or via a telephone conversation with a nurse with training in pre-operative assessment. After completing a health questionnaire we will arrange blood tests and other investigations, such as a heart ECG or a chest X-ray where these are appropriate.
The pre-operative assessment nurses liaise closely with your Consultant Anaesthetist, who will, where necessary, arrange for you have more tests or see another specialist or your GP in advance of the operation. This process is intended to ensure that you are fit to safely undergo anaesthesia and surgery.
On the day of your surgery your anaesthetist will visit you to review your pre-operative assessment with you and discuss your anaesthetic and the plans for post-operative pain relief.
When you are anaesthetised or undergo sedation, the normal protective reflexes are lost. This means that any food or acid in your stomach can potentially be regurgitated and get into the lungs, causing a potentially life-threatening condition (aspiration pneumonia). To negate this risk, it is vital that you abstain from food and drink for a period before the operation.
The current expert recommendations are:
1) Clear fluids – allowed up to 2 hours before the anaesthetic or sedation.
Clear fluids include water, clear fruit juices, and black tea/coffee. Avoid juices with particles in, milky tea or coffee, and alcohol.
2) Light meal – allowed up to 6 hours before the anaesthetic or sedation.
Examples of a light meal include toast, boiled or poached eggs, breakfast cereals (alright to have with milk) and fruits. You should avoid any fried or fatty foods, as these can take much longer to digest.
Often there are several people having operations by the same surgeon on an operating ‘list’. Many factors determine the actual order of an operating list. Because of these factors the timing of 2 hours or 6 hours referred to above should be calculated backwards from the beginning of the operating list.
This means that:
1) For a morning list you can have a light meal up until 2:30am clear fluids until 6:30am.
2) For an afternoon list, you can have a light breakfast up until 7:30am and clear fluids until 11:30am.
3) For an evening list, you can have a light meal up until 11:30am and clear fluids until 3:30pm.
Prior to your operation you need to prepare to be out of work anywhere from 3 weeks to 6 months, (varying upon the level of physical exertion needed in your work and the type of surgery you are having). Discuss with your surgeon for more details. It is important to remember that whatever information you are given is a guide to recovery based on the average patients. No surgeon can accurately guarantee a set recovery time, as everyone heals at their own individual rate. It is important to remember that while complications are rare they do typically set back by weeks the recovery period.
A large number of patients dismiss the information given by their surgeon, please take on board all the advice given to you. Most patients struggle with the idea of being off work for a considerable period. It is also often difficult to appreciate the reasons to be out of work. Most people tend to underestimate the time associated with recovering from foot surgery.
Try and think about all of the things you are likely to need in the days immediately after your surgery. You may wish to:
You will minimise discomfort post surgery by having important items such as the following within arms reach:
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