Ice
A portable NuPulse compression ice device may be prescribed to you depending on your insurance coverage. This device will provide you with cold and compression therapy which will help reduce postoperative swelling, pain, and healing time, and in many cases reduces the need for painkilling narcotics. If you choose to not rent the NuPulse Ice Boot, place a bag of frozen peas or gel packs as they do not leak over the surgical area. You should apply the cold pack or bag of frozen peas directly onto the dressing intermittently for 15-20 minutes at a time several times per day, during waking hours. Do not apply cold packs directly on the skin.
Pain Medication
An oral pain medication will be prescribed to take after your surgery. It is recommended to pick this up prior to your surgery and kept in a safe place at home. Begin taking your medication immediately once your local anesthesia begins to wear off. (Do not get behind in treating your pain. You will take more medicine trying to catch up than if you keep it under control.) Continue taking the pain medicine only when needed and as prescribed. The most postoperative discomfort peaks within the first 72 hours, with each day being more comfortable than the last.
Elevate
For the first two-weeks following surgery, it is important to elevate the operated limb after surgery to limit swelling and drain excess fluid from the foot.
Keep your toes above your nose with several pillows. Avoid putting your limb down for longer than periods of 15-30 minutes. Excessive swelling may cause complications and interfere with healing, and prolong recovery. Performing a gentle range of motion exercises of the ankle is beneficial in swelling reduction and promoting blood flow. These exercises involve moving the foot up/down, forward and reverse circles, and tracing the alphabet with the foot.
Keep Postoperative Boot on at all times when ambulating. You are not allowed to drive if you are wearing a CAM boot or cast or if you are taking narcotic pain medications!
Weight Bearing
If you are weight bearing as tolerated, you may apply weight to your heel only and you must wear the surgical boot/shoe at all times. The surgical shoe or boot will restrict bending of your foot.
You cannot take one step without the shoe/boot until you are cleared by your doctor to do so. You should minimize ambulation for required activities of daily living, such as going to and from the bathroom or kitchen until you are cleared by your doctor to do otherwise. It is advisable to wear a shoe with a lift on the opposite foot such as a clog, mule, or boot to balance out your leg length and prevent hip and back pain.
Non-Weight Bearing
If you are non-weight bearing you will not be able to bear weight for at least 6 weeks after the surgery and up to 3 months if you are diabetic, a smoker, or have any bone quality or density concerns. You may use crutches, a walker, a rolling knee walker or a wheelchair. Refer to our online crutch use instructions. A rolling knee walker takes the pressure off of the wrists and shoulders, but is not always covered by insurance. If you have knee pain from a knee replacement or arthritis, a rolling knee walker will not work for you.
Showering and Bathing
Splints, casts, surgical dressings, and incisions must be kept dry at all times unless you are instructed otherwise by your doctor. We recommend using a water-resistant protective shower cover, which can be purchased in our office or online. Alternatively, you may use heavy-duty garbage bags and duct tape to protect your cast/splint from getting wet. (Scotch tape, rubber bands, etc. will not work). First tape a small bath towel or table cloth around the top of your cast. Pull the bag over and above the top of your cast at least 3-4 inches. Secure the duct tape around the bag, so that it is tight but comfortable. You can tape a second bag over the first bag for extra protection. If you are in a non-weight bearing cast/splint, we recommend using a stool to sit on in the shower. Make sure that the stool is stable while the shower floor is wet to avoid any accidents.
Moisture can lead to skin maceration (skin softening) which can lead to an infection of the skin or incision site, if you had surgery. Plaster cast/splint will lose their integrity when wet resulting in little to no protection of your lower extremity.
Take a hair dryer and set it on cool and blow down the top and bottom of your cast.
Call us immediately at (212) 921-7900 to schedule a cast/splint - check/change during business hours or (917) 426-6647 after hours or on weekends.
Keep surgical dressing clean and dry. Do not get wet, change or inspect the wound dressing bandage.
Routine dressing changes will be performed by your surgeon weekly until your incision has healed. Absorbable sutures are usually used unless there is concern about wound healing due to swelling, diabetes, steroid use, tobacco use, autoimmune medicines, and/or excessive scarring from previous surgery. Non absorbable stitches will be removed 3-4 weeks following surgery. Absorbable sutures usually dissolve within 4-6 weeks. If you have pins in your toe, they are generally removed in the office at the 6 week visit.
When you are discharged from your surgery, you should receive a call the following day after surgery from your doctor to discuss how you are doing and to ask/answer any clinical questions that you may have.
1st Postoperative Visit
Your first postoperative visit will be within 3-14 days of your surgery. A date and time for your appointment will be made for you prior to the surgical procedure. At your first follow up visit, new x-rays will be taken and a new sterile dressing will be applied. Continue to elevate your foot throughout the day and use the Ice boot as prescribed.
2nd Postoperative Visit
Sutures are usually removed fourteen to twenty one days after your surgery, as long as the surgical sites are well coapted. A new sterile dressing will be applied and you will continue to bear weight in the surgical shoe or boot as tolerated. Continue to elevate your foot throughout the day and use the Ice boot as prescribed.
3rd Postoperative Visit
Your third postoperative visit will take place in the third week after surgery. At this visit new x-rays will be taken to monitor bone healing and physical therapy will likely begin. As long as all surgical sites have fully closed, you may begin to get the foot wet while showering. After this visit, you will return to the office twice a week for physical therapy.
4th Postoperative Visit and Beyond
Your fourth postoperative visit will take place in the fourth week after surgery. Physical therapy will continue twice a week until full range of motion has been restored and swelling has been eliminated.
Proper nutrition is critical to ensure healing of the skin to the bones. Eat a well-balanced diet and drink 6 to 8 glasses of fluid (mostly water) everyday. Increase your protein intake. Take the following vitamins:
Smoking cessation is recommended 6 weeks prior to surgery and 1 following surgery. Multiple studies have shown that smoking has negative effects on bone, skin and wound healing as well as fusion procedures.
Desk job
It is recommended to take 2 weeks off work to rest at home with your feet elevated. However, if you are unable to take time off from work, you may return after 3 days as long as you are not taking any narcotic pain medications, have a way to get to and from work, and can sit with your leg elevated at all times when working. Avoid excessive and unnecessary ambulation.
Light duty
If your work involves standing on your feet, you may be allowed to return to work 2-6 weeks after surgery with limitations on the amount of time you are allowed to stand, and the amount of weight you are allowed to carry. It takes a minimum of 6 weeks for bone to demonstrate early healing from fractures or fusions and 4- 6 months before they are remodeled and strong enough for unrestricted weight bearing, impact type activities, and high heels.
Hard Labor
Expect 4 months before a full return to work. If light duty work is available, then restrictions as above.
You will be given your Doctor’s cell phone number should you have any questions or concerns regarding your post-operative care.
CALL YOUR DOCTOR OR THE OFFICE at (212) 921-7900 if:
At Gotham Footcare in NYC, we strive at recognizing your individual needs and desired outcomes while formulating an effective and personalized treatment plan with the highest quality care available.
What sets Gotham Footcare apart from other podiatry offices is our dedication to providing you with the education you need to make well-informed decisions regarding your care. Regardless of what your foot and ankle trouble may be, at Gotham Footcare our team will work tirelessly to help you feel better. At Gotham Footcare, we help you put your best foot forward.
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