AFTERCARE

Find out what you can expect recovery to be after surgery

 

COMMON QUESTIONS ABOUT SURGERY

 

WHY DO YOU ADVISE ELEVATION?

You should always elevate your leg after foot or ankle surgery. This is because gravity pulls fluid down so if you do not elevate after an operation, the leg will swell and this puts pressure on wounds (increasing the risk of dehiscence and infection) and is painful. Strict elevation is needed for the first two (and ideally up to six) weeks and thereafter, be sensible.

HOW HIGH DO I NEED TO ELEVATE?

The ideal level is to keep your operated area higher than the level of your heart since this is the 'pump' which keeps blood moving around your body. This is obviously not always practical but if you are in bed or resting on a sofa, this means propping your feet up on a few pillows.

HOW QUICKLY CAN I RETURN TO DRIVING?

There is no defined criteria but before driving after foot or ankle surgery, you must decide if you feel safe to do so and confident of performing emergency braking without difficulty. Most patients return back to driving after eight weeks if they have not worn a plaster, or if they have had a plaster, then two to three weeks after this has been removed.

DO I GET A LIGHTWEIGHT PLASTER AFTER SURGERY?

Some operations need a plaster cast to be applied to help protect the surgery whilst healing occurs. The first plaster applied in theatre is a 'back slab.' This is the traditional plaster which has an uncovered area typically over the front of the leg. This first plaster is usually heavy but is more flexible than the lightweight plaster so accommodates swelling much better. If you still need plaster after your 2 week wound check, this can be a lightweight fibre-glass plaster. Click here for more information about looking after your plaster.

COMMONLY PERFORMED SURGERIES ARE EXPLAINED BELOW

ACHILLES TENDON DEBRIDEMENT WITH HAGLUND'S REMOVAL

This surgery involves an incision above your heel overlying the 'pump bumps.' The swellings within the tendon will be removed along with the bone bump (Haglund's deformity) which is thought to cause it. You will be in a temporary plaster for two weeks during which time no weight is allowed on the leg. The blood supply to the skin in this area is not good so wounds are at an increased risk of infection and dehiscence. You must therefore strictly adhere to elevation and follow guidance on weight bearing. After two weeks, you will return to clinic for a wound inspection and application of a new plaster on which your full weight is allowed. Nonetheless, you should keep the leg elevated as much as you can tolerate and four weeks after surgery, your plaster will be exchanged for a medical walking boot. Driving can resume from four to eight weeks after surgery depending upon whether you have a manual or automatic car, and whether surgery was on the left or right leg. Wasting of the calf muscle is common due to immobility so you should work with a physiotherapist from week six to rehabilitate. Swelling is usually improving from four months and full recovery takes six to 12 months.

ANKLE ARTHROSCOPY

Recovery is dependent upon the reason why you are having surgery but in most cases, you should be allowed to bear weight fully with crutches immediately after surgery. During the first two weeks, you should keep the leg elevated as much as possible which reduces swelling. You should start circular, and up and down range of motion exercises which will reduce scar tissue formation internally. You will return for a wound inspection at two weeks, and then gradually increase activity levels. Swelling typically improves after three months and full recovery takes between six and twelve months.

BUNION CORRECTION AND BIG TOE FUSIONS

Approximately 9 out of 10 surgeries of this type occur without without any major complications. Assuming that is the case, you would be allowed to weight bear immediately using a special shoe and use crutches for six weeks. This protects the bones whilst they heal. During the first two weeks, you must strictly elevate the foot (and ideally at a level higher than that of your heart) for most of the day. This reduces swelling which reduces pressure on your wounds which allows them to heal faster. Between weeks two and six, you should keep the leg elevated as much as you can which again will aid swelling longer term. There is no set time on this but be sensible. If you start doing too much and it starts swelling and becoming painful, that is your body's way of telling you that you are overdoing it. At six weeks, an x-ray will be taken and if that is satisfactory, you can stop using the shoe and crutches, transition back to soft, comfortable shoes and commence foot range of motion exercises to help recovery. Swelling normally starts to come down from four months and full recovery is achieved at 12 months. Click here for more information on the risks of surgery.

FUSION OF THE ANKLE, HINDFOOT AND MIDFOOT

Fusion of bones other than in your toes requires a minimum of three months in plaster. You cannot put any weight on the leg in the first month, 50% weight in the second month, and full weight in the third month. Fusions typically lead to a lot of swelling so you should strictly elevate the leg (ideally higher than your heart) for two weeks and then as much as you can tolerate. If the plaster starts to feel tight as you do activities, you need to slow down and elevate the leg more. After three months, your plaster will be removed and you will be prescribed a cushioned walking boot which most patients use for six weeks as they transition in to normal footwear. Often this transition is limited by swelling and this can take up to twelve months to reduce. In some cases, the swelling remains permanently. A major complication in fusion is the bone not healing and if this appears to be the case, then an external bone stimulator may be needed which helps promote healing in approximately 50% of cases.

LIGAMENT STABILISATION

Repair of the ligaments on the outer aspect of your ankle will require between 2 or 4 weeks in plaster. This depends upon the quality of your tissues and whether a synthetic augment is used. During this time, you will not be allowed  to bear weight on the operated leg, but can do so when out of the plaster and in an ankle brace. Physiotherapy should commence after removal of the plaster and whilst the brace is typically worn for six weeks, this is guided by how well you establish muscle control and stability. Patients typically report that they have returned to a good functional level by four months, although it can take up to twelve.

MORTON'S NEUROMA REMOVAL

There is no restriction to weight bearing after Morton's neuroma removal surgery. However, you will be wearing bulky bandages and consequently have to use a surgical shoe for two weeks whilst the wounds heal. You should keep the leg elevated during this time and after your two week wound check, regular massage of the scar with a silicone scar gel which can be bought from any pharmacy is recommended.

TIBIALIS POSTERIOR TENDON RECONSTRUCTION

The surgery needed varies between individuals depending upon which structures have been affected and what the pattern of deformity is. Most cases require a cut in the heel bone, a ligament repair and tendon transfer. Additional procedures include breaking or fusing bones in the midfoot and using a blocking screw to stop the arch collapsing. Your foot will be allowed to heal in half plaster cast for two weeks, then return for a wound check and be placed into a full plaster cast for an additional four week. You are not allowed to bear weight on the operated leg for six weeks. After this, you will be allowed to bear weight but will need to use a medical walking boot for four to six weeks as you transition to your own footwear. You must keep the leg elevated for six weeks, and thereafter as much as you can tolerate. Swelling starts to reduce from six months and takes up to 12 months.