Pre and Post Operative Instructions

Preoperative instructions:

-You will receive a surgical boot or shoe if applicable. Please bring this with you on the day of surgery.

-Stop taking all Aspirin, Ibuprofen, Advil, Aleve and other NSAIDs 7 days before surgery. A “baby” 81mg aspirin is OK if prescribed by another physician. Tylenol is OK to use up to the day of surgery.

-Inform the doctor if you are on weight loss medications or are in a pain management program.

-Please inform the doctor of any heart disease, clotting issues or breathing issues prior to surgery.

-The doctor will call in your pain medications for surgery the day before surgery. This may include up to 3 medications depending on your procedure, history and other medications:

-Diclofenac 75mg twice a day: This is a long-lasting anti-inflammatory medication. Do not take additional NSAID medications.

-Gabapentin 300mg 1 hour before bed: This is a nerve blocking medication that helps to prevent post-surgical pain.

-Hydrocodone/Acetaminophen: This is a narcotic pain medication intended for severe pain. Patients may take 1-2 of these as directed.

-The doctor may write for additional medications from a pharmacy called EBM:

-Shower Guard: This is a device to prevent water from entering the surgery site while showering after surgery.

-Scar Gel: This will be used around 4 weeks post-op for scars. Do not start using until directed.

-Bone health supplement: This is for boney procedure and can aid with healing and fusion of joints.

-Preoperative labs will be ordered. These can be done at Lab Corp, Sonora Quest or at your PCP.

-Additional information may be needed including preoperative History and Physical with Risk Stratification from Primary care, EKG and/or cardiac clearance.

-The doctor may suggest a DVT pump for blood clot prophylaxis. This may be covered by some insurances. If it is not covered by your insurance, a device may be purchased for $200.

-The hospital or surgery center will contact you on the week of surgery to go over payments, where and when to show up and to go over any pertinent medical information.

Postoperative Instructions:

-Please note that not all instructions may apply to your procedure. The doctor will let you know if there are any deviations to this plan. Please inform the doctor of any questions you may have before deviating from these instructions.

-Contact the clinic immediately or go to the emergency room if you have severe pain, redness spreading up the foot, pus coming from the wound, fevers, vomiting or chills.

-Contact clinic and go immediately to the emergency room if there is intense calf pain and swelling or if you have difficulty breathing. This can be a sign of deep vein thrombosis or pulmonary embolism, which may be life threatening.

-Contact our clinic at 480-632-5757 with any concerns. There is an after hours line that is available to reach the doctor in an emergency situation. If the doctor does not answer, they will attempt to contact you back as soon as possible. This call may come from an outside or unkonw area code or number.

Immediate Postoperative to Week 1-2:

-A pain block may have been given behind the knee by anesthesia or at the ankle. This will provide relief for 24-48 hours.

-Do not place weight on the foot until sensation in the foot has fully returned. Once the nerve block has worn off, patient should begin weight bearing in the boot with crutches or walker.

-Try to walk 10-15 minutes per hour in the boot to encourage blood flow.

-Begin taking Diclofenac and Gabapentin if prescribed.

-Begin taking 1-2 hydrocodone/acetaminophen as prescribed once the numbing block has worn off. Start when the pain is 3-4/10. Do not take additional Tylenol or NSAIDs unless directed.

-If pain continues after taking the pain medication, unwrap the brown ace bandage layer. Keep the white gauze layer intact.

-Ice behind the knee or at the ankle. DO NOT PLACE ICE ON THE INCISION SITE!

-Elevate the operative leg. This does not need to be above the heart.

-Do not change the dressing unless otherwise instructed, or in case of:

               -If there is bloody strikethrough to the ace bandage layer.

               -The bandage becomes wet in the shower.

               -If your follow up is in 2 weeks, you may change the dressing after 1 week.

               -You may be prescribed a collagen dressing to change after the first week.                     Additional instructions will be provided in this case.

-Call our office to schedule a follow up appointment for 1-2 weeks post-operative unless otherwise instructed.

-Always wear the walking boot except showering and when relaxing. Wear the boot to bed unless otherwise instructed. Do not walk in or weight bear on the boot for the first 3 days unless otherwise instructed.

-Follow up x-rays will be taken in office at week 1-2.

-Sutures will be removed around week 2.

-Begin toe range of motion exercises. Remove the boot and gently grasp the toe near the joint and pulling upward until there is a comfortable stretch. Hold for 30 seconds to a minute and release. Do that 5 times in a row 3 times a day.  Ankle range of motion exercises can be performed by pointing the toes and writing the alphabet. Gentle circles with the ankle can also aide in range of motion.

Week 1-2 to Week 6

-May increase walking in the boot to pain tolerance without crutches or assistance.

-Continue to walk at least 10-15 minutes per hour while awake.

-You may begin using the scar gel if the incision is fully healed without scabs.

-Continue to ice, elevate and use compression.

-Continue gabapentin and diclofenac as needed.

-Continue toe range of motion exercises.

-Continue ankle range of motion.

-Skilled Physical Therapy can start at this time if needed.

-Swelling is expected and normal during this phase of healing.

-Numbness in the foot is normal and should resolve with time.

-Stem Wave therapy may be recommend at this time.

Weeks 6-12

-May begin driving after right foot surgery in an athletic shoe or post-operative shoe if given clearance by the doctor.

-May begin weight bearing in athletic shoes.

-OK for barefoot walking in the house 10-15 minutes per hour to help range of motion if cleared by the doctor.

-OK to start low impact activity including:

               -Light walking. Low inclines and slow speed.

               -Elliptical

               -Stationary bike

               -Swimming

               -Rowing

-OK for body weight exercises. No pressing weight lifting exercises (deadlifts, squatting, lunging) unless cleared by the doctor.

-The doctor may recommend orthotics to aid in recovery and prevent recurrence of conditions.

-Light swelling is normal during this phase of healing.

-Numbness in the foot is normal and should resolve with time.

-If you have need for surgery on the opposite foot, we will begin the scheduling process.

Weeks 12-16 and Beyond

-OK to start into impact activity if cleared by the doctor. Start with linear activity such as jogging and may slowly progress to court sports if cleared by the doctor.

-OK for weight lifting if cleared by the doctor

-Continue range of motion.

-Continue orthotics.

-OK for normal shoe gear when comfortable.

-Continue scar gel

-Continue compression, icing and nsaids as needed

-Light swelling may continue but should resolve with time

-Stiffness in the foot is normal and should resolve with time

-Numbness in the foot is normal and should resolve with time.

-Follow up appointment at 6 months and 1 year post-operative are recommended

-If you experience pain along the internal fixation or have loosening of the internal fixation, it can be removed after the bone has healed. The fixation can otherwise stay in the foot for life. It is unlikely to set off metal detectors.

Additional Information

-The doctor may recommend Extra Corporeal Shock Wave (ECSW) otherwise called Stem Wave. This is a physical therapy modality that uses ultrasound to aid in healing, blood flow, swelling and pain. It is highly recommend to use this in order to speed recovery, lower pain, increase range of motion and return to activity faster. We offer this service at our facility for $800 for 6 sessions for our post-operative patients. Additional sessions may be purchased for $150 per session.

-PRP injections (platelet rich plasma) may be recommended for recovery. These can aid in the reducing pain and swelling, increase range of motion and help with cartilage recovery in the joint. We offer this service for $600 per injection.

-Orthotics may be recommended to help with toe range of motion and prevent recurrence of the condition. This may be a covered benefit for some insurances. Orthotics may also be purchased for $500 for the first pair and $250 for any additional pair.

-Please contact our office at 480-632-5757 if you have any concerns.