Ice decreases swelling and pain. Apply an ice pack to the front of the ankle. A second ice pack should be applied to the back of the knee. Keep the ice in place for 20 minutes, and then remove it for 20 minutes. This will be very helpful. Do not fall asleep with ice on your skin or this could cause frostbite. After the first few days or week, when there is less pain/swelling, you can discontinue using ice.
It is extremely important that you keep your post-operative dressing intact and DRY. If you accidentally get your dressing wet, return to the office or to the ER for a dressing change. A wet dressing may allow your incision to get infected. The office sells air-tight waterproof cast shower bags. These have a pump which is inflated to create a seal on the leg, above the cast.
STAY OFF IT
IF you’re told to be non-weightbearing: your splinted/casted foot can rest on the bed or floor but there should be NO weight applied to your foot. Helpful Devices: Crutches, Knee Scooters, Walkers, Wheelchairs.
- Roll-About Knee Scooters– these are great for patients that must be non-weightbearing but must get around quickly or travel long distances. These can be rented at local pharmacies; generally cost $40/week. Alternatively, you can find these about $150 on CraigsList.com. Once you’re done with it, you should be able to resell it and recoup your cost.
- Pain Medications. After surgery, your foot/ankle will be numb. As it starts to "wake up," you will start to feel pain. Start taking your narcotic pain pill to stay ahead of the pain. If you are still numb on the night of surgery, take a pain pill prior to going to bed. Generally, the day following surgery is the worst - you may need to schedule your pain medications every 4 hours. As your pain lessens on subsequent days, you will space out the medication and stop taking it altogether. Anti-inflammatory medications (ibuprofen 800mg with breakfast, lunch and dinner) can then be used to help with a more mild pain and swelling (do not take these anti-inflammatory medications if you have been told not to take NSAIDs for any reason). Narcotic prescriptions cannot be phoned into your pharmacy.
- Nausea could occur as a side effect of your anesthesia or pain medications. If you are prescribed an anti-nausea medication (Zofran or Phenergan), you can fill this prior to surgery or only if needed.
- Blood Thinners are generally not required following foot and ankle surgery. Depending on your risk factors, Lovenox injections may be prescribed. Aspirin 325mg might also be prescribed. If so, start these the evening of surgery. Continue this every 24 hours as instructed.
METABOLIC FACTORS INFLUENCING HEALING
- Vitamin D activates calcium to grow new bone. Depending on what surgery you have, we may assess your Vitamin D levels. Normal is considered 20-30nmol/L. For major bone fusions, the preferred range is 50-100nmol/L. We may supplement your with Vitamin D if indicated.
- Smoking? Stop! Your chance of complications will be higher. Discuss with your PCP if you are willing to try Chantix.
- Diabetes. Control your blood sugar levels. Compliance with medication and proper dietis necessary.
Complications of Surgery
- Nausea - See Above.
- Allergy following surgery is likely due to your pain medication. Benedryl can help. Stop taking the pain medication and notify our office. Severe allergic reactions should be treated as emergencies.
- Constipation following surgery is also likely due to your pain medications. Purchase Dulcolax stool softener at your pharmacy, if needed. As you reduce your narcotic use, this will improve.
- Infection following foot surgery typically presents with fever and clinical signs (the area can be red, hot, swollen and painful). Notify our office immediately if there is concern for infection.
- Blood Clots are unlikely to following foot and ankle surgery. They are most likely in patients with a personal or familial history of blood clots, obese patients, those on hormonal replacement, and those who smoke. One-sided leg swelling, cramping and calf pain may indicate a blood clot in the leg, also known as a deep venous thrombosis (DVT). If a DVT breaks loose, the clot can travel to the lung (venous thrombis). This can impair breathing and cause sudden death. Signs of venous thrombosis include: shortness of breath and chest pain. If there is concern for DVT or venous thrombosis, call 911 immediately.
- On-Call Physician is available during non-business hours for emergencies. Call the regular office phone number to be connected.