Preparing for Your Surgery
Foot and ankle surgery is a specialised area of orthopaedic surgery. The surgery can be quite challenging and every patient is different with unique needs and goals.
You will need to follow instructions, perform appropriate exercises, and modify your activities during your healing process.
This requires patience, persistence, and a desire to get better. If you are unable to complete the post-operative instructions it will affect your results and you should consider alternative treatments. Successful results from surgery require a contribution from you.
Whenever surgery is considered we always try to minimise the risks. You are already on this path by consulting an experienced orthopaedic surgeon who is a specialist in foot and ankle disorders. The body is a very complex and varied structure so although we aim for perfection, no specialist can give perfect results every time.
It is important that you read all of the information carefully. If you have any questions or concerns, or are not certain about the benefits, risks, limitations, or alternatives to your treatment, please do not hesitate to ask Dr Zilko.
There are a number of important things you can do to get your body ready for foot and ankle surgery:
- Diabetes Control. It is critical that your blood sugars are under optimal control at the time of surgery and in the weeks post-operatively. Ideally, they should regularly measure between 4 and 8mmol/L. Poorly controlled diabetes around the time of surgery leads to an increased risk of infection, higher rates of wound complications, delayed healing of bone fractures and joint fusions, and slower recovery overall.
- Smoking. You must try to quit smoking prior to any foot and ankle surgery. Multiple research studies have shown infection rates and wound complications to be many times higher in smokers than non-smokers. Bone, joint and soft tissue healing is also significantly impaired in smokers. Given the much higher risks, some operations will not be offered to smokers, such as ankle joint replacement and major joint fusions.
- Weight loss. If you are overweight or obese, then losing weight prior to surgery is an important goal. Increased body mass means that more force is transmitted through your foot and ankle bones and joints, and this is often a major cause of pain and disability. In some patients, weight loss alone can help pain from arthritis enough to alleviate the need for surgery. Obesity increases the risk of infection and wound complications, and also leads to joint replacements wearing out at an earlier stage than in patients with a healthy weight.
Before Your Operation
Once you know your surgery date, it is important to make plans for your post-operative recovery period. The first one to two weeks after any foot and ankle surgery generally requires you to rest at home and elevate your leg, so having a family member or friend to help with everyday tasks like meals, cleaning and laundry can be useful.
You will also need to keep bandages and plaster casts dry, so you might also need help with showering or bathing. If your bedroom is not on the ground floor, then consider whether you should move a bed downstairs if you are non-weightbearing on crutches or other walking aids.
For Your Hospital Admission
- The hospital does not provide crutches or frames, so please hire a set from your local pharmacy if you are to be non-weightbearing after your operation, and bring them into hospital with you.
- If you will be non-weightbearing for a while, you may find a knee scooter useful. Ask Dr Zilko’s rooms for more information if you are interested.
- Please remove all make-up & nail polish from your feet.
- On the morning of surgery, please shower and thoroughly wash your feet and toes with soap and water. If you are having a major operation such as a fusion or joint replacement then you should wash with the anti-bacterial chlorhexidine wash provided to you.
- Wear loose fitting clothes to hospital that will fit over a cast, moonboot or surgical shoe.
- Fast from the time instructed. This will generally be midnight for morning surgery, or 0630 for afternoon surgery.
- On the day of surgery do NOT take any insulin or diabetes tablets unless otherwise instructed (if you are normally on insulin please confirm with the rooms that we have this information). Blood thinners (eg warfarin, clexane, Plavix, Iscover) should have been stopped one week before surgery. Aspirin is usually safe to take before the operation, but not on the day of surgery.
- Otherwise please take your normal medications (eg blood pressure tablets) with a small sip of water on the day of surgery.
- Arrive at the hospital at the time advised to you. Please bring a book, magazine or music in case of a moderate wait or delay. Leave valuables & jewellery at home.
- Remember to bring your surgical shoe or boot if this was supplied in the rooms, as well as any hard copies of x-rays and scans.
- You must make arrangements for a responsible adult to take you home after your surgery. It is strongly suggested that someone stay with you during the first 24 hours or until you are able to get around safely.
- A physiotherapist may see you in hospital to give you instructions as to walking, weight bearing, exercises and the use of any aids (eg crutches).
- Once you can safely mobilise and your pain relief is adequate, then you can go home.
- Once you arrive home, wait until you are hungry before eating. Begin with a light meal such as a sandwich, fruit, tea, coffee or juice. A heavy meal can cause nausea and vomiting after an operation.
- Plan to rest and elevate your leg after surgery to minimise swelling, pain, bleeding and wound complications – this is very important. The catch phrase is “toes above the nose”! Your foot must be above the level of your heart so that gravity can help to reduce your swelling. Sleeping with your leg elevated on pillows can be difficult, so you may wish to consider purchasing a foam ramp to help stabilise your leg at night. Several patients have used a pre-made ramp from Clark Rubber with good success.
Post-Operative Pain Relief
- A local anaesthetic block will be given to you during surgery by Dr Zilko or the anaesthetist. This will produce numbness in the region of your surgical procedure. It will provide you with pain relief for approximately 8–12 hours post-operatively enabling you to be comfortable and to sleep after your surgery.
- You will be discharged home with some prescription pain relief medication. It is important to take oral painkillers before the anaesthetic block wears off. If you wait until you are in severe pain, you will find it much harder to control your pain, and will actually end up needing more tablets than otherwise.
- For the majority of foot and ankle operations, you should not need strong painkillers for more than 5-7 days. After that point, paracetamol (Panadol) should be adequate.
Time Off Work and Driving
Time off work and recovery will depend on the nature of your surgery. Generally, a minimum of one to two weeks is required off for seated or desk work (unless very minor surgery). For more prolonged standing or walking this will often require at least 6 weeks off work.
Driving is not allowed in the first few days after surgery whilst on strong painkillers. If you’ve had surgery on your right foot or ankle then you generally need between 2 and 6 weeks off driving, depending on the procedure. If it’s your left foot (and you drive an automatic car), you can usually drive 7-10 days after surgery.
You should check with your car insurance company to ensure that you will be fully covered when you re-commence driving.