General Patient Information

Foot and Ankle surgery is specialised surgery with specific and extensive rehabilitation. The postoperative protocols are of utmost importance to ensure a positive and successful outcome. Please look at the general recommendations below to ensure positive outcomes.

Post-operative care

Dressings

A bandage or below knee cast will be placed depending on procedure undertaken but will be discussed with you by your surgeon.
It is important to take care of your dressings and to ensure that these dressings do not get wet.
Dressing protectors and shower covers are available at the rooms or at Dischem pharmacies.
Please do not remove your dressings or casts yourself. If any problems arise, please contact your surgeon.

Stitches

Absorbable subcuticular stitches are used for most cases.
If any nylon sutures are used these will be removed at your 2-week follow up.
The wounds and dressings must always stay dry and in place.

Pain medication

Your anaesthetist may give you a block behind the knee or in the foot which will reduce the postoperative pain for 12 to 24hrs. This will be discussed by your anaesthetist in more detail.
You will receive oral analgesics and/or anti-inflammatory medication upon discharge.

Swelling

Swelling in foot and ankle surgery is detrimental and must be always avoided.
Swelling can cause wound breakdown and infection.
To prevent swelling strict bed rest and foot elevation is recommended for the first 2 weeks post-surgery. The foot should be elevated above the heart (continental pillows or 3 to 4 pillows always works well). Mobilising to bathroom and back only is advised.
After 2 weeks mobilising around the house can be increased systematically.

Mobilisation aids and devices

Surgery of the foot and ankle will hamper your walking during recovery.
Crutches or a mobilisation scooter will be recommended to help you to mobilise easier while staying non weight bearing or partial weight bearing. Your surgeon will give you more information depending on the surgery required.

Thromboprophylaxis

Foot and ankle surgery can have an increased risk for deep vein thrombosis and pulmonary embolism, especially in cases where cast application and non-weightbearing is required.
More detail around this will be given to you from your surgeon.
If you are in a cast, thromboprophylaxis will be prescribed for a duration of 4-6 weeks. This will be to reduce the risks of blood clots forming.

Vit D supplements

Vit D supplements will be prescribed in cases of osteotomies or arthrodesis. This has been shown to increase union and decrease complications significantly.

PLEASE CONTACT YOUR SPECIALIST IN CASE OF:

Infection
- Infection is a risk associated with any surgical procedure. It is possible to treat with antibiotics easily and effectively if detected in the early stages.
- Symptoms include:
  - A body temperature above 38.0°C.
  - Drainage of foul-smelling fluid from the wounds.
  - Excessive redness, pain, burning, or temperature increase around the wound.

Signs of blood clots in the lungs or legs
- Unfortunately, blood clots are a potential risk with any surgical procedure. It can be life threatening if it is ignored, but it can also be successfully treated if diagnosed early enough.
- The incidence in foot and ankle surgery is low, and thromboprophylaxis will be given to you by your surgery in cases with higher a risk.
- Symptoms include:
  - Sudden onset shortness of breath or chest pain.
  - A swollen, tender calf muscle. The muscle may feel harder than the non-operated side.
  - Pain in the calve when flexing the ankle up towards the knee as to stretch the calf muscle.
  - Stiffness only after foot surgery is normal.

If your toenails and toes have a blue greyish discolouration.

Advise for the following 6 to 12 weeks after foot & ankle surgery.

Foot and ankle surgery has an extensive recovery period, but once that is over you will have a significant improvement of your quality of life. Be sure to arrange your schedule in such a way so that you have sufficient time to recover and are not pressed by the stressors of general life.

It is important to allow yourself at least 2 weeks bed rest and elevation to prevent swelling and wound complications.

It may be necessary to temporarily reorganize your house and housework, or to get assistance for the first few weeks.

You will not be able to drive for the period that a prosthetic shoe, moon boot or cast is applied. You will only be allowed to resume driving once you are transitioned back into a normal shoe/tekkie (driving of an automatic car may be earlier if the left foot is operated).

You may sleep on either side, but it is advised to sleep with your prosthetic shoe in place. Special circumstances will be discussed with your surgeon.

Return to work:
- This will depend on the specific work requirements as well as surgery performed.
- The first 2 weeks strict bed rest and elevation will be required.
- If administrative work via a computer is possible, working from home from approximately 2-3 weeks post operatively may be possible.
- For more physical work, one may have to wait until mobility is restored, usually ranging from 6-8 weeks.
- Longer duration of work may be required for more extensive pathologies and surgical procedures and can be discussed with your surgeon.

Smoking has detrimental effects on foot and ankle surgery. Smoking causes decreased union and increases wound breakdown and infection. This is because smoking reduces the amount of oxygen being delivered to the tissues, which is vital for the healing process. It also contributes to lung, heart, and other medical problems.
- Please stop smoking a minimum of 6 weeks before surgery.
- Your surgeon may ask you to stop smoking before he continues to do your surgery to minimise risks of complications.

A healthy weight will make the technical aspects of the surgery easier, decrease your complication rates and improve your recovery and rehabilitation.

Physiotherapy and/or biokinetics will be crucial to your rehabilitation and will be discussed and prescribed by your surgeon.

Scar management should start between 4 and 6 weeks post operatively. This will entail gentle massaging of the surgical scars with bio-oil or vitamin-e oil. This will assist in breakdown of the deep scar tissue, preventing scar contractures and ensuring a soft scar. It will also decrease the size and width of the scar and create a lighter scar.

ROLE OF
PHYSIO THERAPY
POST OPERATIVELY

To reduce swelling and pain.
Improve range of motion in the foot and ankle.
Improve muscle strength and flexibility of the leg.
Assist with gait training and mobilisation devices.
Assist with balancing and proprioception of the leg.
Enable you to function on a normal level to carry on with your normal daily activities.

Role of Biokinetics in rehabilitation:

Biokinetics will only start once the pain after surgery is under control and the physiotherapist is satisfied with the progress made.
This transition usually occurs between 6 and 12 weeks postoperatively and will be discussed by your surgeon.
The focus will be on progressing the strengthening exercises and to improve your balance, proprioception, agility and flexibility and functional readiness to return to sporting activities and more demanding activities of daily living.
This final phase of rehabilitation is very important, as muscle weakness and imbalance can be detected and corrected in advance to prevent re-injury of the operated leg.

Complications in foot and ankle surgery

Foot surgery can be a life-changing procedure, offering relief from chronic pain and restoring mobility. However, foot surgery can have potential complications like any surgical procedure. Understanding these risks and knowing how to avoid them can help you have a smoother recovery and achieve the best possible outcome. In this section, we will explore some common complications associated with foot surgery and provide tips on how to minimise your risk.

Infection

Infections are one of the most common complications after foot surgery. While surgical techniques and sterile environments minimise the risk, infections can still occur. This may require antibiotics or surgical debridement.
How to Avoid infection:
• Follow Post-Operative Care Instructions: Dr will provide detailed instructions on how to care for your incision. Keep the bandages, dressings and casts dry at all times. Continue with strict elevation protocols to allow soft tissue to heal.
• Keep the Wound Covered: Change dressings as recommended, and keep the wound covered to prevent exposure to bacteria.
• Watch for Signs of Infection: Redness, swelling, increased pain, or discharge from the surgical site may indicate an infection. Contact Dr immediately if you notice any of these symptoms.

Nerve Damage

Nerve damage can occur during foot surgery, regional or local pain blocks, pre-operative injury, or post operative swelling. This may leading to numbness, tingling, or loss of sensation in areas of the foot. The sensation can return up to 18 months post surgery, or in rare occasions not at all.
How to Avoid nerve damage:
• Choose an Experienced Surgeon: Ensure your surgeon is highly experienced in foot surgeries and has a track record of successful outcomes.
• Discuss Concerns Pre-Surgery: Before the procedure, discuss the surgical plan with Dr, including how it’s planned to avoid nerve damage.

Delayed Healing

In some cases, the surgical site and bone may take longer to heal than expected, which can increase the risk of infection and other complications.
How to Avoid delayed healing:
• Follow Nutritional Guidelines: Proper nutrition is crucial for healing. A diet rich in vitamins C and D, zinc, and protein can support the body’s healing process.
• Avoid Smoking: Smoking can significantly slow down the healing process by reducing blood flow to the surgical site. If you smoke, consider quitting before your surgery.
• Manage Chronic Conditions: Conditions like diabetes can delay healing. Keep your blood sugar levels under control and follow any specific instructions provided by your healthcare team.

Pain and swelling

Persistent pain and swelling after foot surgery can hinder recovery and reduce mobility. Long term pain and pain syndromes can occur after surgery. Although very rare, if happens will need referral to neurologist or pain specialist. Some swelling following foot surgery is considered normal.
How to Avoid pain and swelling:
• Rest and Elevate: Resting and elevating your foot as much as possible in the first 2 weeks following surgery can help reduce swelling and pain. Listen to the foot afterwards and elevate as much as possible.
• Ice Therapy: Applying ice to the affected area can help manage swelling. Apply the Ice one hour on, 3 hours off. Ensure the dressings does not get wet.
• Pain Management: Take prescribed pain medications as directed but also discuss alternative pain management techniques like physical therapy and relaxation exercises.

Stiffness

Due to surgery and scar formation, soft tissue fibrosis may cause stiffness around the joints with decrease range of movement

How to avoid stiffness:
• Physiotherapy: Physios will assist in soft tissue management, stretching and range of motion rehabilitation to regain as much function and movement as possible

• Soft tissue management: Tissue management and massaging with bio-oil, soft tissue oil, Vit E oil will decrease soft tissue fibrosis and assist in regain of function.

Blood clots (DVT)

Blood clots, also known as deep vein thrombosis (DVT), can develop after foot surgery, particularly if you are immobilized for a long period.
How to Avoid DVTs:
• Medication: In some cases, Dr (or Anaesthetist) may prescribe blood-thinning medications to prevent clot formation.
• Stay Active: Start moving your foot and leg to promote blood circulation according to the physiotherapy protocol. Even gentle movements can help prevent clots.
• Use Compression Stockings: Wearing compression stockings as recommended can help reduce the risk of DVT by improving blood flow in your legs.
• Stay hydrated: Drink enough water.

Scar Tissue Formation

Excessive scar tissue can develop around the surgical site, which may cause pain or limit mobility.
How to Avoid scar tissue formation:
• Scar Management: After surgery, Dr may recommend scar management techniques such as massage, silicone sheets, or topical treatments to minimize scar formation.
• Physical Therapy: Engaging in physical therapy as advised can help break down scar tissue and maintain flexibility.

Recurrent Deformity

In some cases, the foot may revert to its pre-surgery deformity, requiring additional surgical intervention.
How to Avoid recurrent deformity:
• Adhere to Post-Surgical Guidelines: Dr will provide specific guidelines on how to protect your foot after surgery. This may include wearing a surgical boot, avoiding certain activities, and attending follow-up appointments.
• Engage in Rehabilitation: Physical therapy plays a crucial role in maintaining the alignment achieved through surgery. Attend all recommended sessions and follow the exercises prescribed by your therapist.

Non-union and Mal-union

Occasionally the bones may fail to unite or fuse. This may cause other risks and complications as infection, recurrence of deformity, ongoing swelling and pain.
This is minimised by optimising patient general health, optimising surgical techniques, surgical implants, and post-operative patient protocols and compliance.

Hardware Prominence

Screws and fixation devices inserted during the surgery may become prominent and uncomfortable. They can be removed at a later stage if needed.

• Physiotherapy and soft tissue management may prevent sensitive scars and soft tissue.

Final Thoughts

Foot surgery can offer significant relief from pain and improve your quality of life, but being aware of potential complications and taking proactive steps to try avoiding them is essential for a successful recovery.

A good outcome cannot be 100% guaranteed, but by choosing a skilled surgeon, following post-operative care instructions, and engaging in proper rehabilitation, you can minimize your risk of complications and enjoy the full benefits of your surgery.