How long to ice after foot surgery

Foot and ankle surgery is a specialised area of 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 postoperative instructions it will affect your results and you should consider alternative treatments.

Whenever foot and ankle surgery is considered we always try to minimise any risks. You are already on this path by consulting an experienced specialist who exclusively treats 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.

Successful results require a contribution from you.

This information package is intended to provide you with pre-operative, surgical and post-operative instructions in regard to your surgical procedure.

It is important that you read all of this information carefully and bring it with you when you come to hospital. If you have any questions or are not certain about the benefits, risks and limitations of your surgery, ask your surgeon.

What do I take to Hospital?

• Your X-rays.

• Documentation about your Health Fund.

• Pathology Results.

• Medication.

• Any letters from doctors.

• Any questions that you have written down and wish to ask.

Will I need someone to take me home AFTER SURGERY?

You must make arrangements for a responsible adult to take you home after your surgery. This is advisable if you have either had a day procedure or if you are in hospital for a period of time. We recommend you have someone stay with you during the first 24 hours or until you are able to get around safely.

What should I wear TO HOSPITAL?

Wear loose fitting clothes that are easy to put on and will fit over bulky bandages or surgical dressings. Leave any jewellery and valuables at home. Please remove make up and nail polish. Shower either the night before or the morning of your surgery. Pay particular care that your feet and toe nails are clean.

Local Anaesthetic Block for Pain Management

A local anaesthetic block may be given to you during surgery. This will produce numbness around the nerves in the region of your surgical procedure. It will also provide you with pain relief for approximately 8-12 hours after your operation, enabling you to be comfortable and allow you to sleep after your surgery.

Discharge Home AFTER FOOT OR ANKLE SURGERY

• Plan to rest after surgery to minimise bleeding and swelling. Your particular instruction sheet will give you a specific period of time.

• Have someone who is responsible available to take you home, as you will not be allowed to drive.

• 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.

• Take your medication for pain as directed.

• If required, a physiotherapist may see you while you are in hospital to give you instruction as to walking, weight bearing, exercises and use of any aids. (eg. crutches).

• Once you can demonstrate that you can safely use crutches, able to negotiate stairs and that your pain relief is adequate, then you can go home.

Post-Operative Instructions

These instructions are important in helping you rehabilitate from your foot or ankle surgery. Please follow them carefully. If there is anything you do not understand, please ask.

Rest

It is important that you rest and keep your foot elevated as much as possible for the first 7-10 days to encourage healing and discourage wound break down.

Pain Management

Pain is better treated before it arrives. A regular regime of pain killers taken in the post-operative phase is very important. We recommend that you take regular analgesic, Digesic or Panadeine Forte 4-6 hourly initially, while pain is moderate to severe, however after that period it is recommended that you take regular Panadol up until your post-operative visit.

• Please take analgesic 2 hours prior to your post-operative appointment.

Two hours before going to bed take two analgesic to help you sleep.

If you have any problems taking any of these medications please let the medical staff know.

There is no need for you to be in constant pain.

Elevation

Swelling can delay wound healing and cause the wound to break down. Swelling can be due to over-activity and not keeping your foot elevated and this can also increase the risk of infection. Place your operated leg on two pillows or a bean bag so that your foot is above the level of your hip when you are lying down. The use of ice packs (or frozen peas, beans etc.) can be a very effective way to reduce swelling. Place the ice pack in a towel over the ankle or foot for 20 minutes 3-4 times per day.

Exercise

While you are resting it is important that you do passive gentle movement exercises. This is to encourage your blood flow to your foot, strengthen muscles and prevent joint stiffness. The exercise information given to you by your surgeon or the physiotherapist is designed to help with your rehabilitation and to gain the best results after surgery. Continue with your exercises once you are home and up until your post-operative appointment.

Dressings

Keep your bandages/cast clean and dry. Leave in tact until your post-operative appointment.

When showering/bathing, wrap the dressings or cast in a plastic kitchen or garbage bag and seal the top of the bag above your dressings with tape.

Post-Operative Problems

If after reading and following the post-operative instructions you are experiencing any of the following problems please call the rooms:

Infection

• Wounds feel hot and tender.

• Unusual discharge from your wound or dressings or an odour from your dressings.

• You may have a fever or feel generally unwell.

Swelling

• Swelling is not reduced with elevation of the leg.

• A change in colour of your toes or coldness in the feet.

• The calf muscle in your lower leg of the treated foot swells or is painful.

Bleeding

• Your dressings are showing excessive amounts of fresh blood.

• Elevation and application of pressure dressings doesn’t stop the bleeding.

Pain

• The medication that has been prescribed for you is not helping control the pain while you have been resting with your limb elevated.

Medication

• You are experiencing ill effects due to the medication that has been prescribed for pain eg. nausea, vomiting, gastric discomfort.

Please contact Mr Mark Blackney’s rooms on (03) 9417 0762, or Mr Terence Chin’s rooms on (03) 9116 5827 if you require further information.

After the surgery

• You will need to have a designated driver to take you home.
• Follow the written and verbal postoperative instructions that have been given to you.
• Plan on doing nothing more than resting and elevating your limb for the first two weeks after your surgery.
• Keep your cast or bandage dry and do not change it.
• Resume your normal medications, unless directed otherwise.
• Take your pain medications as directed.
• Do not smoke.
• You can eat and drink a normal diet but pain medication can cause constipation so a diet that is high in fibre may be helpful. Plenty of protein, fruit and vegetables will provide the nutrients that are best for healing.
• Call us, your normal doctor or the emergency department if you experience any “warning signs”.

Warning signs:

• Contact a doctor if you experience any of the warning signs below. If it is after hours contact your local emergency department.
• Severe foot pain that is not relieved with elevation, ice, and medication.
• Fever over 38.5 degrees C, or lymph node tenderness in the groin.
• Severe calf pain, shortness of breath, or chest pain.
• Adverse reactions to prescribed medications.

Usual recovery time

The recovery time following a foot or ankle operation varies widely, depending on factors including how complex the surgery was, your age and general health, and your compliance with instructions (such as weight bearing status, rest, elevation). For most foot and ankle operations, tenderness and swelling can take 3-4 months to resolve, while for more complicated procedures, the recovery may take a full year (or more).

Your first return visit

On your first return visit, your cast or bandage will be removed for the first time. You should be aware that the foot and ankle will look nothing like it will when it is finally healed months down the line. In fact, for some patients, the sight can be somewhat alarming, given that the bandages may have dried blood on them, your foot and ankle may be somewhat swollen and bruised, and you may see stitches at the incision site(s) although often dissolving sutures are used which are invisible.

If you have a cast on your leg, the cast will be removed by our orthopedic casting nurse on your first return visit. If you just have a bandage, but no cast, the bandage will be removed. I will see you once these tasks are completed. When I see you, I will assess your progress and review the recovery plan that I want you to follow until our next visit together.

Resuming footwear

The problems of bone healing and swelling prevent early return to normal footwear following most foot and ankle surgeries. There are a few operations where a patient can be expected to resume wearing standard footwear in as little as 2-3 weeks but the majority of foot and ankle operations take at least 8 weeks before standard footwear can be attempted. If the surgery requires a cast, then there is typically a 2-4 week period of weaning back to shoes after the cast is finally removed (a removable walking boot may be used during this weaning period).

Therefore, if the surgery requires a cast or boot for 3 months, then you can expect to be in standard shoes no sooner than 14-16 weeks. I will discuss my expectations for your return to standard footwear with you both preoperatively and postoperatively.

Return to work

Since virtually all foot and ankle operations require rest and elevation of the operated foot for at least 2 weeks following surgery, it is rare that a patient will be allowed to return to work before 2 weeks following surgery. If you work in a sedentary occupation and can arrange your work environment so that you can continue to keep your foot elevated, it might be possible to return to work under these circumstances at approximately two weeks following some foot and ankle procedures. If you work at a job that requires you to be on your feet for a substantial portion of the workday, it is rare that you would be allowed to return to work in less than 8 weeks following your surgery. In more complex surgeries, patients may be required to remain off work for as much as 3-6 months. I will discuss my expectations for your return to work with you both preoperatively and postoperatively.

Resuming activities

Activities are usually progressed gradually in the following sequence: very restricted activities of daily living (ADL) with mandatory rest and elevation, restricted ADL with rest and elevation, full ADL with restricted footwear, ADL with standard footwear, non-impact exercise activities with standard footwear, and finally, full weight bearing exercise activities. The time it usually takes to progress through these levels is typically months, and is dependent upon how complex the surgery was, your age and general health, and your compliance with instructions (such as weight bearing status, rest, elevation). Therefore, it may take 2-6 months before full weight bearing exercise activities are started. Before full weight bearing activities are allowed, non-impact exercise activities may be allowed, including activities such as core strength work, upper body weight lifting, swimming, stationary cycling, and elliptical trainer. I will discuss my expectations for your return to activities with you both preoperatively and postoperatively.

Rehabilitation

Most foot and ankle operations require some form of rehabilitation. In most cases, I will give you instructions on the type, frequency, and duration of rehabilitation activities. These activities may include range of motion exercises and strength work that you perform on your own. In some cases, working formally with a physiotherapist may be required, for which I can make a referral. Rehabilitation activities may be started in some cases immediately after surgery, while in other cases, will be delayed until a cast or boot is removed. In most cases, rehabilitation activities may last for 2-12 months.

Should you have any unanswered questions, please call us on 096300214