General check and fitness for surgery
During the initial consultation with your surgeon, a thorough medical and medication history will be obtained from you.
Important history includes that of heart and lung disease, kidney disease, cancers and treatments received, deep vein thrombosis and pulmonary embolism, diabetes, smoking and alcohol consumption, previous surgery on the foot and ankle and other relevant surgery.
Important medication history: blood thinners like Warfarin, Apixaban, Plavix, Asasantin and other newer agents. Biologics and Immunomodulators used for long-term treatment of rheumatoid arthritis, SLE, psoriasis and other inflammatory conditions will need to be discussed further with you.
When you and your surgeon have agreed to proceed with surgery, the next step involves signing a surgical consent form. This involves making an informed decision about your treatment after having received sufficient information on the risks and benefits of surgery as well as having understood the non-operative treatment options for your specific condition.
Anaesthetic options will be briefly discussed with you and further handouts are available upon request.
We will email/provide you with a procedure specific information sheet prior to surgery which will also direct you to the hospital website to complete your admission paperwork.
Individual hospital websites have more detailed information about your admission process and hospital stay. This includes details on physiotherapy services and discharge protocols.
Preparation for surgery
We encourage you to plan ahead especially with regards to leave from work and organising home help in the initial weeks after surgery.
Rates of complications vary for each procedure. Generally, the risks average 5 -10%. The specific risks of each procedure will be discussed with you at the time of signing the consent form for the operation.
- Post-operative pain
- Numbness of the foot
- Delayed wound healing
- Removal of metalwork due to irritation- this is usually performed through a smaller incision once your surgeon has deemed healing to be adequate.
Longer term complications
- Non-union (failure of bony surfaces to fuse together)
- Failure of bones to unite despite our best efforts can occur due to multiple factors. If you continue to smoke, your healing with be prolonged or may cease altogether. Non-compliance with non-weight bearing may also contribute to delayed/non-union.
We give you antibiotics at the start of every operation and operate in a sterile environment after adequate cleaning and disinfecting the foot we are operating on. We ensure dressings remain intact until you are seen in our rooms for a follow up appointment. However, despite our best efforts as a team, feet still do get infected. They are closer to the ground and also suffer from a reduced blood supply being further away from the heart. If you continue to smoke, your risks of infection are higher.
- Complex regional pain syndrome/Reflex Sympathetic pain syndrome
- Abnormal pain response to surgery or trauma
Risk factors for complications
- Being overweight (BMI > 25) or obese (BMI > 30)
- Pre-existing circulation problems
- Previous or ongoing infection
Recovery will vary depending on the procedure you have undergone. Generally, driving is not permitted for 6 weeks following surgery whilst you are in a special shoe, boot or cast.
This will depend on the nature of surgery you have undergone. Generally, forefoot surgery patients are allowed to weight bear as tolerated in a special post-op or Darco shoe soon after surgery. Fusion operations and fractures involve a period of non-weight bearing for around 6-8 weeks. Patients who have had surgery on their Achilles can expect to weight bear as tolerated soon after surgery in a CAM/Moon boot.
If you are managed non-weight bearing following surgery, you will be required to take 300 mg of aspirin whilst you remain non-weight bearing.
If you have had a previous deep vein thrombosis or pulmonary embolism or are deemed to be at high risk for developing one, then you will be required to take an injection of Clexane everyday beginning on the morning after your surgery.
Crutches/frames and physiotherapy support will be provided by the hospital at the time of your discharge. Any additional home supports may also be organised by them.
If you are discharged after 5 pm, the physiotherapist from the hospital will contact you the following day to give you further instructions over the phone.
Discharge from hospital
Most patients are discharged the morning after surgery given that your surgery is performed after 2 pm on the day of admission.
Minor day surgery patients may stay overnight if they wish but would usually be expected to go home later that evening if comfortable.
All dressings should be left intact until the follow up appointment with your surgeon. In case of excessive bleeding, the dressings should simply be reinforced over the existing bandages whilst keeping your foot elevated.
Your first follow up appointment will be arranged prior to surgery.
Subsequent appointments will be organised during the course of your recovery.
Generally, you will be seen at 1-2 weeks, 3-4 weeks, 6-8 weeks after surgery and then at intervals depending on the type of surgery you have undergone.
Please see contact at the top of this handout and call or email us asap. We are available 24×7 to help support your recovery. If you have a concern or complication, we would want to know and help you get through this difficult time. Sometimes GP’s and emergency departments may not be aware of the details of the surgery you have undergone and may be unable to provide you with the best possible care.
Recovery will vary depending on the procedure you have undergone. The pain you feel immediately after surgery should start to settle at 2-6 weeks, however, it is not unusual to have some discomfort for up to a few months following surgery.
Depending on the type of surgery you have undergone, you will usually be able to start putting weight through the operated foot at 6-8 weeks. Following bunion and other forefoot surgery, you will be able to walk on the operated foot soon after surgery.
Major fusion operations require longer healing time and you will need to protect your foot in a boot for up to 3 months or longer depending on the progression of healing.
You will be provided information on exercises and long-term conditioning during your consults. Referral to a physiotherapist will be arranged as required.
You should not undertake any long-distance travel within 6 weeks of having surgery. Please discuss your travel plans with your surgeon prior to undergoing surgery.
Driving is usually not permitted for 6 weeks after surgery. This period will vary depending on how long you have been advised to remain in a boot, special post-operative shoe or plaster cast. The law prohibits you from driving in a plaster cast, moon boot or a post-operative shoe.
Most patients achieve good to excellent results following surgery. The aim of surgery is to relieve your pain and improve your function. You should expect some pain and discomfort following surgery which will settle in a few weeks; however, it is not unusual to have some discomfort for a few months after any form of foot and ankle surgery.