Planning Ahead For Smoother Surgery
The decision to have foot surgery isn’t something to be taken lightly. In instances where you have exhausted all appropriate conservative treatments and are still experiencing pain, you may find yourself in a similar position to tens of thousands of Weil Foot & Ankle Institute patients in the past. If the time for surgery seems imminent, it’s critical to have an open conversation with your podiatrist about the type of surgery recommended. In discussing your surgery with your podiatric surgeon, it is also important to have a good grasp on the recovery time involved as well as what the days and weeks following surgery will look like. Post-operative restrictions and changes to your daily life need to be considered. Being prepared physically and mentally can make surgery and recovery as seamless and painless as possible.
Optimizing your overall health and ensuring that you are safe to undergo anesthesia are considerations before we even talk about the date! We look at our patients as a whole person – not just a foot. That means that with some underlying medical conditions and depending on the surgery that is planned, you may need to see another doctor (or a couple) before you undergo surgery. Patients with a cardiac history will often need to see their cardiologist to ensure that anesthesia does not pose undue risk. Patients with diabetes must optimize their blood glucose in advance of any elective surgeries.
In most cases, preoperative blood work is performed to assess whether any underlying conditions need to be addressed before surgery. Bloodwork usually involves some basic electrolyte and glucose levels, but also gives us some general information about your underlying body systems’ function. With patients who have diabetes, it is critical to know how well the blood sugars have been controlled historically as this can greatly affect healing potential and post-operative risks. In certain populations, chest x-rays and EKG’s may be needed to ensure you are in good shape for anesthesia.
Your Preoperative Visit
You will likely have a preoperative visit with your surgeon. This provides you the opportunity to ask any questions you have and obtain clarification on any necessary information. You will likely leave with paperwork which reiterates important preoperative considerations as well as provides you with post-operative care instructions and red flags to look out for afterwards. If you have any specific concerns about surgery, anesthesia or recovery (and I mean ANY), write these down before your visit. In most instances, your questions will be answered in the surgical discussion. If there are any points that are NOT covered, it can be difficult to remember your concern when you are sitting in the exam chair. Having these written out in advance lessens the chance that you forget to ask those pressing questions.
Understanding Your Surgical Plan
Your surgeon will provide you with information to help you understand what will be done once you are asleep in the operating room. It is important to have an expectation on incisions and if any hardware is being used for your surgery. This can help you to understand recovery and the postoperative course. Your surgeon will educate you on the procedure being performed to an extent that you have an understanding of expected healing times as well as expected time of recovery. In some instances, your surgical course might revolve only on your incision healing, while others require protection and altered activity for months afterwards.
Details About The Day Of Surgery
Your preoperative visit will prepare you for what to bring to the surgical center or hospital where your surgery is planned to occur. You will need to have a designated driver on surgery day in order to ensure that you get home and set up with your foot elevated and start icing after the procedure is over. In some instances, you may be staying overnight in the hospital and if this is the case, your surgeon will let you know. The type of anesthesia you will be having is dependent on the procedure, your surgeon’s recommendation and also your anesthesiologists assessment. Some more simple cases are performed under monitored anesthesia care (MAC). This type of anesthesia is when an intravenous medication is used to help you fall asleep into a comfortable deep nap. In these cases, you are breathing without the assistance of a machine. You will be monitored by the anesthesiologist during the procedure. General anesthesia is often used in cases where the procedure is longer or more involved. A breathing machine is used in this case to ensure safety during the procedure. Local anesthesia is used in nearly all surgical cases of the foot. Local anesthesia describes the use of injectable medications which provide numbness and blocks nerve conduction to allow comfort during and after the procedure. Local anesthesia is most often used in combination with either IV sedation or general anesthesia. The type of anesthesia used can provide information about your recovery from anesthesia afterwards as well.
When you get home after surgery, you begin your new temporary occupation of healing. To optimize healing and reduce pain and complications, elevating, resting and icing are used. Avoid dangling your surgical foot down starting right away. Elevating your foot above your heart is best, but having your foot at least level with your hip will help reduce swelling and pain. While you will most likely be numb in the surgical site, staying ahead of the pain is key. In order to do this, I recommend my patients take 1 tablet of pain medication with their first post-operative meal and plan to take medication every 5-6 hours until the anesthetic block (numbness) has resolved entirely. At this point (whether it be on the day of surgery or several days later) you can assess whether pain is well enough controlled with rest, elevating and icing – or if you need to continue or increase frequency of the pain medication. If you are having trouble controlling pain post-operatively, contact your doctor for recommendations.
Another important consideration to help you heal is to ensure you have a well balanced diet. Having the nutrients to heal is essential. Get plenty of water throughout the day. Make sure you are eating lean proteins, lots of colorful vegetables and fruits and any supplemental vitamins your doctor may have recommended.
The Postoperative Course
After surgery, the baton is handed off to you, the patient. We as surgeons will do our best to optimize your surgical results and recovery. Once you get home, your success is more greatly related to your adherence to your surgeon’s instructions than you may realize. Your surgeon will provide you with information about how much activity is allowed. We will tell you whether you can put weight on your foot and if so, how. Surgical restrictions can include a period of non-weight bearing (no weight put on your foot at any time), heel weight bearing, or perhaps limited full weight bearing.
After foot surgery, splints, casts, boots and post op shoes are commonly used to protect the surgery site and allow for protection and accommodation for the bandaging as well as post-operative swelling. Your doctor will let you know whether you can take off said protective device at any point in the post-operative period (perhaps it will be ok for you to remove it for icing, but in some cases you may need to leave the device/cast/splint on and undisturbed between your post-op visits.
Pain medication is typically needed in various forms. In many instances a few days of narcotic pain medication may be needed. While this is important to ensure your comfort after surgery, it does come with some possible side effects. Having dulcolax and a water bottle at the ready will be helpful to reduce the risk of constipation. If you have had trouble tolerating narcotic pain medication or anesthesia in the past, anti-nausea medication can be provided by your surgeon. Your doctor will instruct you on the frequency and dosing that is appropriate for you.
Your doctor needs to check in with you throughout the course of healing at scheduled post-operative appointments at the office. Typically your first post-operative appointment will involve assessing the site of surgery and getting a new bandage in many cases. The subsequent visits can involve x-rays to assess for healing. Your surgeon will also guide you as your limitations change during the course of recovery. Physical therapy may be indicated at some point during your recovery as well. If you are concerned about the time commitment of physical therapy, discuss with your doctor whether they will be recommending PT after your surgery so you can adequately prepare.
Taking Care Of YOU
After surgery, the better you are at taking it easy and resting, the better your surgical outcome will be. Your body has the potential to heal and that healing happens best if your body does not have additional stressors. If you are instructed to rest and elevate, the more you do this, the less stress there will be on the incision and surgical site from swelling and that means less pain and less need to use narcotic pain medication. Doing too much after surgery can lead to injury (not just to the surgery site) and can also result in the need for additional post-operative visits and in some cases further surgery. This is your chance to be lazy. In preparing for surgery, think of some games, books or TV shows/movies that you have had on your list for years. Consider yourself successful if you get through some of those things while you are laid up. So what happens then to all the work you usually do? Who else will take care of this? These are important questions to answer before going through surgery. Lining up care from family members, friends or hired service is critical. Think through your daily and weekly schedules. If you can get ahead on work and/or prepare some meals and get the house in the best shape before surgery, this may also ease your mind and ensure you can rest and recover.
Foot surgery isn’t a walk in the park. However, if you prepare yourself mentally and physically, you will be able to take each day of recovery at a time and have the optimal experience. Whether you are considering scheduling surgery or you already have, think about what life will look like for the short term and if you need more information to prepare, reach out to your doctor. We want you to have the best and most seamless experience and are here to provide you the information which helps you achieve this.