GENERAL ADVICE AFTER SURGERY
Advice for the first 2 weeks after surgery
Swelling - Minimise this by keeping your foot elevated on pillows/cushions as much as possible. Aim to have your foot elevated for 50 minutes of every hour.
Pain - Pain will be minimised by keeping your foot elevated and taking pain killers as prescribed. Aim to take the painkillers regularly. It is far better to prevent pain than to treat pain as and when it is experienced.
Bleeding – You may get some light bleeding through the bandages or casts. This is sometimes to be expected. Keeping the foot elevated will help prevent or minimise this. If the bleeding continues then it is advised to contact the ward or clinic for further advice.
Rest – Rest as much as possible, and keep the foot elevated when resting. Try to keep mobilising to a minimum and only when necessary.
Avoid smoking. Smoking is known to increase infection rates, lead to wound problems, and stop the healing of bones and prevent fusion of fusion procedures. It is also associated with increased risk with clots in the leg and lung.
Walking - keep walking to a minimum. Ideally the foot should be elevated (above the hip level, with pillows) for 50-55 minutes of every hour. This will minimise swelling, help the wound to heal, and reduce your risk of wound problems and infection.
Each operation has an individual post-operative plan in terms of weightbearing, follow up, X-rays, plaster/boots and medication. This will be discussed in detail with you are your recovery progresses.
Swelling often takes much longer to subside and settle than one would expect. Swelling is often persistent and can take at least 6 months to a year to settle and plateau. The more elevation you can do immediately after the surgery the better the swelling will be.
Functional recovery times will vary for each patient. Most patients will still be recovering from surgery even after 6 weeks from their operation. As a general rule at around 3 months there is a significant improvement in recovery, and most patients will begin to notice an improvement in their condition. By 6 months patients should be comfortable with activities of daily living and by 12 months the vast majority of patients will have returned to full activities.
Mobilising and walking after surgery
After the first 2 weeks following surgery, walking and weightbearing, if allowed, this should be kept to a minimum if possible. I tend to say 'listen to your foot', such that if the foot is swelling, feels uncomfortable, or there is pain/discomfort, then it is advised to reduce the amount of walking you are doing.
Some operations require metal screws or plate, and therefore recovery usually takes longer - usually 6-8 weeks before walking is more comfortable. Operation that don't require any metalwork usually have a slightly quicker recovery and is usually 3-5 weeks before walking is more comfortable.
Wearing normal shoes after foot and ankle surgery
Although each surgical procedure has estimated times to recovery, swelling reduction, normal walking and return to sports etc, patients are often surprised as to how long it can take to be able to get into their “normal” shoes. Depending on what the exact procedure has been some patients can take longer to get their normal shoes on than others. For example after 6 weeks following bunion surgery the surgeon would be happy for the patient to fit back into normal shoes, but in some cases this may take longer. It is therefore advisable when you are “able” to wear normal shoes that you first wear softer, wider fitting shoes like trainer type shoes and gradually move into narrower, firmer shoes if wanted.
Driving after surgery
It is the responsibility of the driver to contact their insurer and to ensure they are fit to drive the car and can prove they are in control of the vehicle at all times.
As a clinical guide, if you can stamp your feet firmly down i.e. when performing an emergency stop, and you can depress the pedals individually and safely with your feet then you are potentially fit to drive.
Patients who have surgery on their left foot and drive automatics can potentially return to driving sooner than those with foot pedal controlled clutches.
Returning to work after surgery
Everyone and every job is different.
Each surgery is very different and possibly a more manual and active job will take longer to return to than a sedentary position.
It is important to appreciate that commuting to and from work should be taken into account when planning a return to employment and this may be affected by your rehabilitation or immobilisation.
As a general rule, it can take 4 to 6 weeks to return to sedentary jobs and at least 3 months to return to heavy manual labour jobs. Often a period of work duty amendments are required in the lead up to returning to work. Each case can be discussed individually.
Risk of clots in the leg
Generally the risk of DVT (deep vein thrombosis/blood clot) from flying is very low however certain risk factors can potentially increase your risk of DVT. These risk factors include:
Age over 60
Immobility, for example, if you have had an operation or prolonged bed rest
Travelling for long distances with restricted leg movement
Previous history of a blood clot
Family history of blood clots
Inherited condition causing your blood to clot more easily
Cancer, Chronic heart disease, inflammatory bowel disease, kidney disease or other long-term illnesses
Contraception pill that contains oestrogen, or hormone replacement therapy (HRT)
Prophylactic medication is generally given to major operations which require casting treatment. This is usually for 2 weeks until your mobility is improved.
Operations which do not require plaster treatment generally do not require prophylactic medication. However, if you have any of the risk factors above, it may be advised for a period of prophylactic medication and this can be discussed with your surgeon.
Important last note
This is only meant to be a guideline to help you understand your treatment and what to expect. Every person is different and your rehabilitation may be quicker and slower. This will be advised and guided by your doctor and physiotherapist.