In this article, Dr. Lee answers a few common questions about foot and ankle surgery including topics like swelling, downtime, driving, and more.
Answer: Some swelling after foot and ankle surgery (or
injury) is very common. Typically, patients can expect their swelling
to be the most significant in the first 2-3 weeks. It may even get
worse once the post-operative dressing has been removed as the
dressing provides some compression which limits some of the
swelling. It’s not uncommon for some degree of swelling to be noted
for 5 or more months after surgery or injury. If patients are worried
about the amount of swelling, the swelling is accompanied by increased
pain or redness, or if the swelling is significant and paired with
calf tightness or tenderness, the patient should call their surgeon’s
office immediately to discuss their symptoms to determine if more
testing, such as a leg ultrasound, is needed to rule-out a deep vein
thrombosis (DVT), the formation of blood clots.
In many situations however, the swelling is to be expected and is part of the normal healing process. Unfortunately, in the case of foot and ankle surgery, this may be more involved than other areas of the body. Reasons for this are related to dependency, activity level, and pre-existing conditions.
The foot and ankle are subjective to more hydrostatic pressures because they are the most dependent parts of our body. Gravity simply pushes more fluid into our feet and ankles. This is made worse during periods of inactivity when the muscular contractions in our feet and legs do not help push the fluids back up our legs. Elevating your foot above the level of your heart reverses this gravitational flow and helps reduce the swelling.
Activity contributes to swelling both because of gravity, as I mentioned, and also the number of steps people may take in a given day. After shoulder surgery, for example, gravity helps move the swelling out of the operative area. You aren’t walking or using your shoulder to lift or reach overhead 10,000 steps per day like you are on your feet.
Finally, other factors such as venous insufficiency (blood flow problems), blood vessel or heart disease, congestive heart surgery, previous vein surgery, and other conditions can contribute significantly to post-operative swelling.
Answer: How long you’re required to stay off your
operative foot or ankle is a result of many factors including: the
type of surgery, if bone fixation (plates and screws) were utilized,
other pre-existing medical problems, history of smoking, and
weight. It may also be different from surgeon to surgeon even when
these factors are considered. It’s important that patients know and
understand that restrictions to remain off of your surgical foot or
ankle ('non-weight-bearing', 'limited' or ''partial' weight-bearing')
are in place to protect their operative extremity and the healing
process that needs to occur immediately after surgery. It’s important
to follow your own surgeon's instructions. When ignored, significant
complications with their surgery may occur leading to less than
favorable results, healing issues, and potentially the need for
revision surgery.
Typically, if bones in the foot or ankle have been broken (fractured), cut (osteotomy) or fused (arthrodesis) the patient can expect some period of non-weight bearing or partial weight bearing. To help reduce weight placed on the foot or ankle, we use a surgical shoe, boot or cast and the patient may be given crutches, a walker, knee scooter, or wheelchair to help them stay off their foot. Large tendon repairs (such as the Achilles or posterior tibial tendon) require periods off the foot as well. When bone surgery is involved, plates and screws are implanted to hold the bones in proper position during the early stages of healing. This often requires limited motion/weight bearing so the early stages of bone healing can start to occur.
Some medical conditions may cause slower than normal healing requiring even longer periods off the foot or ankle. In these cases, the medical condition can make these periods off the foot even more challenging for the patient to maintain. These conditions include diabetes, rheumatoid arthritis, patients that have undergone gastric bypass surgery, eating disorders, obesity, and renal failure to name a few. Additionally, a long history of smoking (including vaping or chewing tobacco) has been shown to adversely affect healing and therefore slow the process requiring longer periods of immobilization.
Answer: I advise my patients to NEVER drive with a
boot or cast on either extremity. While it may seem reasonable for
patients to expect to drive if only their left foot is in a cast or
boot, they may find themselves taking on increased risk of injury to
themselves or others in doing so. Additionally, their insurance
policies may contain fine print which allows their insurance company
to deny coverage if they are involved in an accident while driving
with a boot or cast on their lower extremities. Finally, different
municipalities and law enforcement agencies may not look favorably on
this practice and could issue a citation for doing so. As a general
rule, patients should refrain from driving while in a boot or a
cast.
Answer: As a general rule, elective surgery is just
that…elective. It’s the patients decision IF they feel surgery is
their best option and WHEN the timing of that surgery is right for
them. I typically advise my patients to consider factors such as work,
travel schedules, season concerns, and how long they feel they can put
if off or “live with” the pain or problem. Some surgeries, such as
fractured bones or torn tendons, need to be fixed in a timely fashion
even if there are options to treat the injury non-operatively.
Often times, the expected post-operative restrictions are a major factor in deciding when the time is right to proceed. Patients with sit-down jobs may be able to return to work much quicker and may have more flexibility in selecting a time. Seasonal workers such as farmers, teachers, or construction workers often look for times when they are either not working or have less busy times at work.
Expected travel or vacations may affect timing as well. Patients should talk to their surgeons about the timing of surgery and the recovery time-frame to determine if a surgery should be scheduled before or after vacations or other major life events. Some conditions will worsen with time and shouldn’t be put off more than a few months.
The final consideration is insurance/financial costs. Many conditions, like bunions, are often put off for years and the patient ultimately decides to proceed with a bunionectomy because they have met their deductible in a given year.