After surgery care
Recovery and rehabilitation
After surgery, it can be challenging to manage new medications, a bulky dressing and simply how to get around.
Please review the information for advice and tips related to your postoperative care. If you have other concerns or questions, please reach out directly to our office to speak with our clinical staff.
Post-surgery guidelines
These guidelines provide general advice for common issues after surgery. If you have any specific concern not addressed here, please contact us.
-
#1 rule: keep your leg elevated (at or above the level of your heart) as often as possible! This is especially important in the first two weeks after surgery to help your incisions heal well and to reduce pain.
• Elevate using pillows under your leg/calf, not just under the heel. Pain in the heel is often caused by pressure from the weight of your foot on the bed.
• If you had a regional block (a type of anesthesia), the foot and leg will be numb for up to 36 hours. While your foot is numb, do not put pillows directly under your heel as this can lead to increased pressure and ulcers, since you won't feel pain. You will feel tingling as your sensation starts to come back.
• Get up once an hour during the day (at least cross the room and come back), but do not stay up for long periods of time. Do this using your crutches or walker if you have them, and following the weightbearing instructions you received. Getting up and moving around helps keep your blood circulating and prevent dangerous blood clots.
• Do not do any excessive walking during the first few days after surgery. Do not plan any activities or travel for at least several weeks after surgery. The more active you are, the more swelling you will have in your foot and the more irritated your incisions will be. This can lead to slower healing and/or infections.
-
Find out from your doctor or discharge instructions about your current weightbearing status. The following is an explanation of each possibility:
• Non-weightbearing: you are to put NO weight at all on your foot. When using crutches or a walker, your foot should not touch the ground, except when you are standing. Then, it may rest on the ground. If you do not follow these rules, you could damage the work done during surgery. (See video below)
• Touchdown weightbearing: you may touch your foot to the ground for balance when walking or when standing. Pretend there is an egg under your foot and you don't want to break it.
• Partial weightbearing: you may bear approximately 50% of your weight on your foot. To get a sense for what this feels like, rest one foot on a bathroom scale until it reads 50% of your bodyweight. (See video below)
• Heel weightbearing: you may bear weight on your foot, but ONLY on your heel. Be careful not to roll through your toes.
• Weightbearing as tolerated: you may put your full body weight on your foot as long as you can tolerate the pain. You may still need crutches if you have significant pain.
-
Resume all medications you were taking before surgery unless otherwise specified.
Blood clots are a dangerous complication of surgery. In order to prevent them, you were prescribed one of several medications. Most often this is baby aspirin (81 mg) twice a day starting the day after surgery. If you are high risk, you may be on a blood thinner such as dabigatran (Xarelto) or apixaban (Eliquis). If you already take a blood thinner, you may resume taking your blood thinner the day after surgery.
-
Pain is a normal part of surgery and recovery after surgery. The goal is to keep pain at a controlled level and minimize the side effects that medications can cause to you. Please follow these guidelines.
• Strict elevation reduces swelling and helps with pain. Keep to your leg elevated as much as possible, especially in the first 2 weeks after surgery.
• Tylenol (acetaminophen) is an excellent pain medication. This should be your first-line medication. You may take 1000 mg every 8 hours for a total of 3000 mg per day. Please note that Medications such as Norco and Percocet contain acetaminophen (Tylenol).
• NSAIDs (like Advil/Motrin/ibuprofen, Aleve/naproxen, etc) are anti-inflammatory and pain relievers that can be taken with Tylenol. They are typically taken regularly for 3 days after surgery and then as needed. Make sure to take with food because they can cause stomach upset. If you are not allowed to take NSAIDs for medical reasons (stomach ulcers/bleeding), please do not take them!
• You are prescribed a narcotic pain medication (oxycodone, hydrocodone). This should be reserved for very high levels of pain after first taking Tylenol or NSAIDs. Patients typically only take them for the first 5-7 days after surgery. You should follow the prescription instructions, but know that you can take these pills less frequently or half a pill at a time. Common side effects include nausea, constipation, dizziness and disorientation.
A short leg splint
A CAM boot with sterile surgical dressings underneath.
Your Dressing
A post-op shoe and sterile surgical dressings.
-
The dressing placed around your foot and ankle is sterile and should not bee changed. Please cover your dressing with a plastic bag or cast cover when showering. You may add extra gauze or ACE wrap to reinforce any minor bleeding through the dressings.
Call your doctor’s office if you notice persistent bleeding, foul odor or the dressing becomes wet or soiled.
-
A short leg splint is a soft cast, typically applied immediately after surgery. It is designed to immobilize and protect your foot and ankle. It's made of padding and plaster and is custom-fitted to your leg. There is extra room within the splint to allow for swelling.
It cannot be removed except by the doctor or orthopedic technicians.
-
For smaller procedures around the toes, you may be able to weigh-bear as tolerated immediately in this stiff-soled shoe. You may take the shoe on and off, but all walking should be done with the shoe. Your dressing underneath should be protected and stay on until your next appointment
-
The controlled ankle motion (CAM) boot is an immobilization device that can also be used after surgery. Typically patients may put weight on the heel of their foot in the boot. The boot should be worn full time, including sleep and completely covered when showering.
Refer to your doctor’s instructions for specific details.
-
You must keep your splint dry. The best way to shower is to cover the entire splint with a plastic trash bag and wrap additional plastic wrap so water does not leak in. Cast covers are also available commercially.
Sit on a chair or stool in your shower.
Do not bathe or try to submerge your leg.
If your splint gets wet, please notify your doctor’s office immediately.
-
It is not easy to ice your foot through the many layers of the splint. It is more helpful to elevate your foot as much as possible afer surgery.
The toes should be near the same level as your heart (on 2-3 pillows) as much of the time as possible, including at night.
Sleeping on your back or the opposite side as your surgical leg are preferred.
-
YOU MAY NOT WALK IN THE SPLINT. It will become damaged and may lead to injury of your foot.
Stay nonweightbearing when in the splint. You may use crutches, a walker or a knee scooter to get around.
The safest way to get up and down stairs is to crawl or to scoot on your bottom.
Driving is not allowed.
-
After your nerve block has worn off, you should be able to feel and wiggle your toes. The color of the toes should be pink. You should be able to feel touch at the tips of the toes.
Bleeding through the bandage can happen--do not be alarmed if you see some blood. Simply add more gauze to the dressing or wrap it in a towel, then call us and we may have you come in for a dressing change. If you think it is excessive, call immediately or go to the local emergency room.
Urgent reasons to call
-
• Fever with temperature > 101 F
• Increasing pain not controlled with pain medications
• Chest pain, shortness of breath, dizziness
• One sided calf pain or swelling
• Cold, numb and pale toes
How do I walk?
Your instructions will list your weightbearing status. The great majority of patients after foot and ankle surgery have to be non-weightbearing. The foot does not touch the ground at all.
Non-weightbearing walking
Using crutches to swing through each step, the operative foot (left) never touches the ground.
In some cases after surgery and often after your follow up visits, you will be allowed to put partial weight on the foot. This means you must share your weight between your foot and crutches or a walker.
Partial weightbearing
When your doctor allows you to put partial weight on the foot, make sure to use crutches. The operative foot (left) and the crutches move forward together so the weight is shared.