Dr. Sham J. Persaud
Post-Operative Instructions for Foot and Ankle Surgery
The following general instructions are guidelines for your post-procedure recovery at home. Due to medication given during your stay, you may not remember these instructions. Therefore, you should review these instructions before your surgery and make sure to keep a copy at home. These should be read and understood before your surgery and you should ask your doctor if you have any questions about these post-operating instructions.
Toes above the Nose
The first few days after your surgery try to keep your foot elevated above your heart to control swelling. This is most likely the single most important thing that you can do to reduce inflammation. You will have the foot down for toilet breaks but try to keep the swelling under control.
The icing serves three purposes:
1. It significantly helps to keep the swelling down, which will reduce the pain.
2. It helps to numb the pain, which will create less of a need for pain killers, which will make you feel dopey, tired, constipated and can create a potential addiction.
3. It will reduce the perspiration under your cast and this will reduce the foul odor and the itching.
You should not ice a leg that is still numb. Twenty minutes on then twenty minutes off is usually a good guide. Place the ice in a plastic bag and wrap it in a towel to absorb condensation to the dressing does not get wet.
First 16 Hours
Those of you that have taken a block, you need to be cautious over the use of your injury. The wonderful thing is that you will feel no pain while the block is working. However, the danger is that you may move your foot too much and significantly hurt your healing process. We suggest, during this period of time, that you just take it easy and put your foot on some pillows and relax.
For those of you who have taken the block, you need to be especially concerned because the block will wear off all at once. Be conscious of any tingling in your toes or your feet because that means the block is wearing off and at that point you should be well medicated. Nevertheless, we recommend that you have some medication after 15 hours and be prepared to increase the dosage once you start feeling any of that tingling and/or discomfort.
The first 24 hours will be the most painful followed by significant pain for the next 24 hours. If you have significant pain after 72 hours, please contact us. Generally, after the first 72 hours, we suggest that you try to start reducing the pain medication. Ideally, continue to reduce the medication to the level that you have very little discomfort while your foot is up in the air and well iced. Any movement of your foot that causes pain will probably give you a good indication that you are at the right level. Meaning that you want to have enough medication so that you are pain free when your foot is not moving during this time period, but not enough so that you do not notice an improper movement to your foot that may hinder the healing.
Some people have problems taking prescription pain medication. If you do, talk to us before the operation. If you are reading these instructions, after the operation, we suggest that you dissolve the medication in a full glass of water. If you are still having problems, we suggest that you take half of the recommended medication doses dissolved in a large glass of water, wait 20 minutes and then take the remainder of the medication dissolved in another large glass of water.
After 72 hours
By now the pain should be at a moderate level and enough for you to start your rehab program. Within the next few days try using Ibuprofen 800mg three times a day to help wean you off the prescription drugs. Unless you have had toe surgery we suggest that you wiggle your toes for 15 seconds and rest for 15 seconds. Do this for four minutes. This should be done approximately 4 times per day, separated by at least four-hour intervals. This will increase the circulation and significantly increase the healing ability of your body to get more oxygen and nutrients to the affected area.
Try to maintain a positive outlook. This will reduce your pain and will promote healing. Of course, this is easier said than done. With the discomfort of having your foot up in the air, packed in ice, constipation and pain, it is hard to be positive. Do the best you can.
Use of Crutches
Many will need to use crutches. Ask us if you need training. Adjust the crutches so the top comes to about two inches under the armpit while you are standing upright. Do not support your weight with your armpits. Use your hands to support your weight. If you develop numbness or swelling in an arm or hand, you are using the crutches incorrectly. If you are having any problems with the crutches, return them.
To get into a chair, support yourself with one crutch on the injured side. Hold the chair with the other hand, and then lower yourself while putting all your weight on the good leg.
Stairs: We suggest that you hold both your crutches in one hand and use the railing. Have someone below you while going up or down to spot for you. Going upstairs is good leg up, step up, and then bring up the crutches and bad leg. Going downstairs is just the reverse. The bad leg and crutches go down first, and then bring the good leg down. You may need to sit down on the stairs and go up backwards one step at a time.
Call Us Immediately If Any Of The Following Occur:
1. Temperature is 101 Fahrenheit or above,
2. Increased bleeding (a small amount is expected),
3. Excessive drainage,
4. If you have any signs of infection, such as redness, yellow discharge, foul odor,
5. Procedure area becomes cold, blue, tingling or numb,
6. Pain is uncontrolled with the use of pain medication while your foot is elevated and iced,
7. Pain is increasing with every passing day (meaning that the pain is worse on the fourth day vs. the second day),
8. Any other questions or concerns that you may have.
While the cast is on, you should protect it at all times from water. You could purchase a rubber boot protector that is designed to be able to go into water without getting your cast wet. Otherwise, you can also protect it by double plastic wrapping the cast and using a rubber band above the dressing. If neither of these two techniques is available to you, it would be best if you just take sponge baths until your cast is removed.
7 Days After
We will see you for your first post-operative visit the week after your surgery on Thursday. There we will perform the first dressing change and inspect your surgical site and incisions. Please note at this time, it is rare that you will be given a refill on narcotic medication. Please use the ibuprofen for your current pain. If you need something more, this will be discussed and you may be prescribed non-narcotic medication to help with your current pain.
Cast/Splint and Bandages
Do not remove the bandages unless otherwise instructed by us. Keep your dressing clean and dry at all times.
After the Cast/Splint/Walking Boot Is Permanently Removed
While you are remaining non-weight bearing please use either crutches or walker to remain non-weight bearing as much as possible. For most cases you may be able to use heel touch weight bearing for transfers. Once you are given permission to begin weight bearing, this should be a gradual transition. Usually, I recommend you begin walking in your home for one hour without the boot and then transition back to the boot for the rest of the day. The next day try two hours and increase an hour a day for a week. Once you reach 7 days you may begin full weight bearing for the entire day. You may want to always have the boot with you for a month afterwards just in case you become too painful and need some support while walking say at the grocery store or during hiking/exercising.
When your cast or boot is removed you will notice quite a bit of soreness in both your tendon and your calf muscle. This is normal. You can help to improve this condition by gently rubbing your calf muscles and if possible your Achilles tendon. This can be accomplished in bed while lying on your back. With your good leg, bend your knee so that it is above the height of your head. With your injured leg place it over your bent knee. Gently move your injured calf and tendon up and down over your knee. This will help increase circulation and will help to remove the scar tissue and it will accelerate your healing capacity. Also once your sutures have been removed and your incision sites have healed, you may begin rubbing and massaging you incision sites with Vitamin E ointment. This will help desensitize your scars and limit hypertrophic scar formation.
We suggest that you use an ice cup. Take a Styrofoam or paper coffee cup, fill it up with water and freeze it. When you are ready for it, take it out of the freezer and cut or tear off the top half of the paper. This makes an excellent icing vehicle. The benefit of this technique is that you can rub it around the affected area and all around the calf, without the fear of getting frostbite. This is because the temperature is never below 32 degrees (freezing) because it is always melting. It will take approximately 7 ñ 10 minutes to get your foot to an iced position. We suggest that you ice it this way at the following times:
1. After every exercise as outlined above,
2. Before you sleep at night, and
3. At any time that you feel warmth.
The word inflammation comes from the Latin word ìflammaî, which means flame. Surgeons see with their hands. We suggest that you start developing a sense of touch and a sense of feel to see when your injury is warm. This means you have inflammation and you should ice it. At first you may not notice the difference, but you will become more sensitive to the sense of touch if you compare the surgery side to the uninjured side. The good foot will be much cooler than the injured one.