Foot and Ankle Surgery Patient Information

DR. SCOTT HOLTHUSEN

STACEY W. (CARE COORDINATOR), MITCH FOGAL, PA-C

Planning and preparing for your upcoming surgery

Table of Contents ImportantPhoneNumbersandResources……………………………………….…….3 FootandAnkleSurgeryOverview……………………………………………………….….4IntroductionandPurposeofBooklet

o Decisionforsurgery…………………………………………………………….5 o Typesofsurgicalprocedures……………………………………………....6 o Expectedsurgicaloutcomes………………………………………………..8 o Therisksandbenefitsofhavingsurgery………………………………8

BeforeYourSurgery

o Importantdetailstoorganizebeforesurgery………………………9 o Assistivedevices…………………………………………………………………10o Preparingyourhomeenvironment:checklist……………………..12

AfterYourSurgery

o Inhospitalimmediatelyafteryoursurgery……………….…………13 o Managingyourrecovery:rest,painmanagement,etc….…...14o Follow-upappointments…………………………………………………….17o Follow-upfootcareandassistivedevices………………………….…18o Physicaltherapyandrecoveryexercises………………………………19o Livingwithyourreconstructedfootorankle………………………..20

ImportantContactPhoneNumbersMedicalQuestions:Mon-Fri8:00am–5:00pm 952-442-8205 -AskforMitchInternetResourcesDr.Holthusen’sPhysicalRehabilitationProtocols

www.tcomn.com/physicians/scott-holthusen

CommonSurgicalProcedures• http://www.footeducation.com/surgical-procedures

Lodging AmericInn 5500CherryDrive Waconia,MN55387 952-442-8787Transportation Water’sEdgeTransportation 952-442-7022

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Introduction

Mostofthetime,wehardlygiveathoughttogettingplacesbywalking.Butwhenourfeethurt,evenashortdistancecanbean

agonizingordeal.

Itisestimatedthatapproximately,75%ofAmericanswillhavefootorAnkleproblemsatsometimeduringtheirlives.

Unfortunately,someoftheseproblemsgountreatedduetothemistakenbeliefthatfootdiscomfortisanaturalpartofgettingolder.Inreality,alotcanbedoneaboutapaininthefoot.

Thefootcontains26bones,33joints,andanetworkofmorethan100tendons,musclesandligaments.Whilethiscomplexstructureallowsustowalk,runandjump,italsoexposesustoavarietyofinjurieswhenwewearimproperlyfittingshoesorsubjectourfeettorepetitivestressinsportsandotheractivities.Ifwehavemisalignedbonesortightmuscles,walkingfunctioncanalsobeimpaired.

Thisbooklethasbeenputtogetherbyourfootandankleteamtoassistyouinplanningandpreparingforyourupcomingsurgery.Itcontainsinformationaboutwhatyouwillexperiencebeforeandafteryourfootoranklesurgery.

“75% of Americans will have foot or

ankle problems.”

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ReasonsforfootandanklesurgeryThedecisionforsurgery-Manyfootandankleproblemscanbesuccessfullymanagedwithoutsurgery.Medication,physicaltherapy,orthotics,shoemodificationorwalkingaids,weightcontrolormodificationofleisure/sportingactivitiesaresuggested.Yoursurgeonmayrecommendyoutrysomeoftheseapproachesbeforeyoudecideifsurgeryisnecessary.Otherfootandankleproblemsmayrequiresurgerytoresolvelongstandingjointpainordeformityortoremovediseasedtissue.Theseproceduresmayhelptoslowdownthedamagingprocessortostructurallyrealignthefootandankleandreduceabnormalstresses.Duringyourfirstvisitwiththefootandanklesurgicalteam,wewillaskyouquestionsaboutyourfootandanklehistory.Wewillexamineyourfootandankletocheckforpain,swelling,opensores(ulcers)rangeofmotion,alignment,strengthandstability.X-raysmaybetakentoallowfurtherassessmentofyourfootandankle.Footandanklesurgeryisconsideredmainlyforthosepeoplewithproblemsthatcannolongerbesuccessfullymanagedbyconservativemeans.Surgeryisperformedformostofthefollowingreasons:

1. Toimprovealignmentandcorrectdeformity2. Toimprovefunction(suchaswalking,standing,bathing,etc.)3. Topreventfutureproblems4. Totreatinfection5. Toreduceorrelievepain

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TypesoffootandanklesurgicalproceduresFootfusions,reconstructionsandjointreplacementsManydifferenttypesofsurgicalproceduresareperformedbyDr.Holthusen.Examplesincludethecorrectionofbuniondeformities,rheumatoidfeet,arthriticjoints,plantarfasciitis,Achillestendonruptures,flatfootandhigharchfootreconstructions,andtreatmentofdiabetesrelatedsores(ulcers).Jointreplacementsurgery,suchasanklereplacementsarealsoperformed.BonesoftheFoot

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GlossaryofsurgicaltermsandproceduresGastrocRecessionAsurgicalprocedurethatreducesthepullofatightAchilles’tendon.ItisusedwhentheAchilles’istightbecauseofashortgastrocnemiusmuscle(abbreviatedgastroc.).AtightAchilles’tendoncancausemultiplefootproblems,includingflatfootandhalluxvalgus.ThegastrocmuscleislocatedinthecalfofthelegandisattachedwiththesoleusmuscletotheAchilles’tendon.Gastroc.SlidesurgerycutsthetissueconnectingthegastrocmuscletothesoleusandtheAchilles’.Arthrodesis(Fusion)Theprocedureofsolidlyfusingajoint(Arthro=joint+desis=fusion).ArthroplastyThesurgicalrefashioningorreplacementofajointtorestorefunctionandintegrity.ArthrotomyIncisionof(cuttinginto)ajoint.CheilectomyTrimming/chiselingofftheirregularedges(arthritis)ofbonesthatinterferewithjointmotion.DebridementRemovalofexcesstissueorbone.OsteotomySurgicalcuttingandrealignmentofabone.Thebonecanbelengthened,shortened,orshiftedtoanewplace.PercutaneousAchillesTendonLengtheningThegoalofthisprocedureistostretchatightAchillestendon.Thisallowsincreasedmotionattheanklejoint.Thisproceduremaybeonlyonepartofasurgerytohelpcorrectamal-positionedfoot.

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WhattoexpectfromhavingfootandanklesurgeryThepurposeofyouroperationistoimprovethefunctionofyourfootandankleandthequalityofyourlife.Insomecases,twoormorebonesmaybejoinedtogetherbyscrewsorplates.Thepurposeofthisistohelpthebonegrowtogetherandformafusion.Atfirst,youwillnotbeabletoputweightonthatfoot.Bytheendofthesecondmonthyourfootshouldbestrongenoughtobeginlimitedweightbearing.Dependingonthesurgery,atthreemonths,youmaybeabletowalkshortdistances.Theswellingonthesurgicalfoot,andtherangeofmotionofthesurroundingjointsshouldgraduallyimproveoverthefirst6monthsandyoushouldbenoticeablybetterthanbeforetheoperation.Improvementwillevenoccuruptooneyearaftersurgery.However,differentpeoplevaryintheirrecoverytime,soyoushouldnotbetooconcernedaboutadelayinyourecoveryaslongthingsareimproving.Additionally,someprocedurestakeayearormoreforrecovery.Complicationsaftersurgeryoccurin5to10%ofcasesonaverage.Yourparticularproceduremayhaveahigherriskofcomplication–yoursurgeonwillinformyouifthisisthecase.Onlyyoucanmakethedecisiontohavesurgery,ornot.Eachsurgeryisdifferentandthetimeittakestorecovervariesforeachperson.

TherisksofhavingfootandanklesurgeryTherearetemporaryproblemsthatincludedelayinwoundhealing,woundinfection,delayinbonehealing,andstiffness.Someproblemsmayrequirefurthersurgerytocorrect.Theseinclude:

• Delayinbonehealing• Painfulscrewsorpins(thesecanberemovedoncetheboneishealed)• Woundhealingproblemsorinfectionrequiringskingraftingorsurgicalcleaning• Unionofthebonesinthewrongposition(thebonemayhavetoberebroken

andrepositioned)• Looseningandwearofthejointreplacementparts.Thisappliestojoint

replacementsonly.

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Therisksofhavingfootandanklesurgerycontinued…Somelesslikelyproblemscancauselong-termcomplications.Theseinclude:

• Reflexsympatheticdystrophyorchronicregionalpainsyndrome(overactivepainresponsetosurgery)

• Nervedamageduringtheoperation(partialnerveinjury=burning;completenerveinjury=numb)

• Failureofthebonestojoin.Smokingcancausedelayedbonehealing.Stopsmokingfourweeksbeforetheoperationanddonotstartagainforatleastsixmonths.

• Infectioninthejointreplacementparts.Arevisionmayberequiredhere• Infectioninthebone

Someproblemsmayrelatetoyourgeneralhealth.Remember,anysurgeryisastresstoyourbody.Complicationsrelatingtoanysurgeryoranestheticinclude:

• Heartattack(thisriskappliesparticularlytothosewithpreviousheartproblems)• Chestinfection(pneumonia)• Reactiontotheanesthesia• Bloodclots.Thesearerareafterfootandanklesurgery.Itisveryimportantto

notifyyourdoctorifyouhavepreviousdeepveinclots.Deathafterfootandanklesurgeryisveryrare,butmaybecausedbybloodclotsorheartattacks.

BeforeyoursurgeryBeforeyoursurgery,thereareanumberofthingsyoucandotoprepareandmakeyourhospitalstayandsurgeryassmoothaspossible.Startbymakingthesepreparations1to2monthspriortoyourscheduledsurgeryifpossible.Pre-surgicaleducationReadallinformationprovidedonyoursurgerycarefully.Keepthisinformationforreference.Werecommendyoubringthishandouttothehospitalwithyou.SmokingAreyouasmoker?Stopsmokingatleastfourweeksbeforeyoursurgery.Ifyouneedhelp,pleasevisitsmokefree.govorwww.helpguide.orgorcall1-800QUIT-NOWforadviceandmoredetailsonhowtostop.Note:Patientswhocontinuetosmokeatthetimeofsurgeryassumeadditionalcomplicationriskduetothemajorinterferencewithbonehealingcausedbysmoking!

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Beforeyoursurgerycontinued…EnsuringgoodhealthandnutritionPriortothesurgery,youshouldbeinasgoodhealthaspossible.Thehealthieryouare,thequickeryouwillrecoverfromsurgery.MobilityindailylifeDiscussanymobilityproblemsyouexpecttohavepriortoyoursurgery.Doyouhavestairsathome?Doyouneedtoinstallaramp?Doyouknowofhowtouseawalkerandcrutches?Makearrangementsinadvanceofyoursurgeryforanynecessaryhomeorworkmobilitymodifications.Akneewalkermaybeusefulandcanbeobtainedbyanyhomemedicalsupplystorewithawrittenprescriptionfromyourphysician.AssistiveDevicesDiscussassistivedeviceswiththephysicaltherapist.Theywilladviseyouregardingpossibleneedsincludingraisedtoiletseat,acommode,orurinalforseveralweeksaftersurgery.Mostmedicalsupplystoresselland/orrentavarietyofassistivedevicesandequipment.Lookintheyellowpagesundermedicalsuppliesforstoresinyourarea.Somepharmaciesalsosellassistivedeviceslistedbelow LocalMedicalSupplyStoresRidgeviewHomeMedicalEquipment501SMapleStSte2Waconia,MN55387Phone:(952)442-2283Fax:952-442-2948LibertyOxygenandMedicalEquipment166717thAveESte102Shakopee,MN55379Phone:(952)445-5454Fax:952-445-5484Hours:

Mon–Fri8:30AM-5:00PMSat10:00AM-2:00PM

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Typicalassistivedevicesthatyoumightneedinclude:

• CAMWalkerboot–givenpriortosurgeryoratfirstpostopvisit• PostOperativeshoe• Crutchesorawalker–BringtoHospitalifyouownthem• Wheelchairwithelevatedfootpedal• Raisedtoiletseat• Showerchair• Non-slipmatinsideandoutsideshowerstallorbathtub• Hand-heldshowerhoseattachment

HolidayandbusinesstravelAswithrecreationalactivitiesandworkrequirements,talktoyoursurgeonabouttravelplansafteryoursurgery.Extendedholidayorbusinesstravelisunadvisableforseveralmonthsaftermajorfootoranklesurgery,andyouneedtobeparticularlycarefulaboutoverseastravel,includinglong-distanceairtravel.ReturningtorecreationalactivitiesDonotcommityourselftoreturningtosportsorotherrecreationalactivitieswithoutdiscussingthiswithyoursurgeon.Forexample,ifyouareplanningtoreturntoaseasonalsport(suchasskiingorsoccer),itisbesttoschedulesurgeryattheendofoneseasonsothatyouhaveamplerecoverytimeforthenextseason.Ifyouareplanningtoreturntoanotheryear-roundrecreationalactivity,suchasskateboardingorintensivepowerwalking,checkwithyousurgeonabouttheseactivities.

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ChecklistforpreparingyourhomeenvironmentYoumayneedtomakesomechangesinyourhometokeepyousafeandmakeyourrecoveryaftersurgerymorecomfortableandefficient.Usethischecklisttodeterminewhatchangesyoumightneedtomakepriortoyoursurgery.

o Installrailingsalongstairs.o Removescatter(throw)rugs.o Reorganizecupboards,closets,refrigerators,andthebathroomandkitchen

sothatitemsyouuseoftenarewithinsafereach.o Makesuretheinsideofyourhomeiswell-litandhasnightlightswhere

needed.o Removemildeworicefromoutsidesteps,andensurethatsteprisersare

secure.o Addpillowsorraisedcushionstolowchairs.Chairsshouldhaveafirmback

andarmrestsforbestsupport.o Removeallplantsandotheritemsfromstairways.o Moveelectricalcordsoutoftheway(butdonotrunthemunderrugs!).o Installagrabbarorsecurehandrailinyoushower,bath,andtoiletareas.o Installahand-heldshowerattachmentforeasierbathing.o Prepareadownstairsbedroomifgoingupstairsisgoingtobeaproblem.o Arrangeforsomeonetolookafteryouhomewhileyouareinthehospital.

Thismayincludewateringplants,caringforpets,andpickingupmail.o Cancelanyservicesyoudonotneedwhileinthehospital,suchasnewspaper

delivery,homemakerservices,etc.o Buyconvenientmicrowavefrozenfoods,orprepareyourownandfreeze

themforreheating.o Discusswithyourfamily,friends,orcaregiverswhatyourtransportation

needswillbetoandfromthehospitalorsurgerycenter,andduringyourrecovery.

o Arrangewithfamilyorfriendstoactas“helpers”whenyougethometoassistwithyourdailyactivities.Thesemayincludebathing,dressing,mealpreparation,errands,groceryshopping,andtransportation.Ifyoualreadyhavehomeassistanceservices,arrangethesetoincreaseintheweeksaftersurgery.Ifyouneedhelplocatinghomeassistanceservices,contactyourhealthcareteamforasocialworkreferral.

o Duringinpatienthospitalstays,socialworkersareavailablefordiscussionofskillednursingfacilityplacements.

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Immediatelyafteryoursurgery

Splints:Afteryoursurgery,youmayhaveasoft“Jones”splintfromyourkneedowntoyourfoot,butyouwillbeabletoseeyourtoes

“Jones Splint”

Footelevation:Youwillneedtostayinbedfor24to72hoursaftersurgerywithyourfootelevateduptothelevelofyourheart.Thishelpstoreducetheamountofswellinginyourfoot.Wheelchairandcrutchesuse:Beforeoraftersurgery,youwillbeinstructedoncrutchuse.Somepeopleneedawheelchair.Youwillnotbesenthomeuntilthehealthcareteambelievesyouaresafetogetaroundonyourown.Ifyouarehavingproblemsgettingaround,youmayneedashortstayinaskillednursingfacilitytobuildupyourstrengthandmobilityskillsuntilyoucangetsafelyaroundonyourown.Weightbearingonyourfoot:Itisveryimportantthatyoudonotwalkonyourfoot.Yourdoctorwilltellyouwhenyouareallowedtoputweightonyourfoot.

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ManagingyourfootinhospitalafteryoursurgeryFootpain:Youwillhavesomepainafterhavingsurgeryonyourfootand/orankle.Youwillhavemedicationsorderedtohelpyoucontrolthispain.Thepurposeofthemedicationsistoreducethepaintoamanageablelevel.Ifyouneedsomethingmoreforpain,orifyoufeelthatyourpainmedicationisnotworking,callourofficetodiscussyourneeds.Poplitealnerveblocks:Duringyouroperationyouranesthesiologistmayinjectalong-actinganestheticagentlikeMarcaineintoyourupperlegwhichwillinhibitpaininyourfootforupto24hourspost–operatively.Askyourorthopedicsurgeonwhetheryoucanexpectthismethodofpaincontrolafteryouroperation.Swelling:Swellingcanbecontrolledbykeepingyoufootelevatedatheartlevelor6inchesabovefor24-48hours.Numbness:Oftenlocalanestheticisplacedinthenervesaroundyourfootduringtheoperation.Youmaynoticenumbnessbutnopainuntilthisanestheticwearsoff.Donotworry–thisisnormal.Reportittothedoctorornursesifitlastsmorethan36hours.Mobility:Remembertokeepyourfootinawalkerbootandoffthefloor.Usecrutches,awalker,and/orawheelchairformobilitysupport.ManagingyourrecoveryathomeafteryoursurgeryThefirstfewdays–rest!Settleintoacomfortableplaceyousetupbeforehavingsurgery,suchasabedorachair.Putyourfootup.Havejuice,water,food.Enjoyyourfamily,takeanap,anddon’tforgettotakeyourpainmedicationasdirected.Whatshouldyoursupportpeopledoforyou?Theyshouldmakesurethereisanadequatesupplyoffluidsnearby,andthatpainmedicationsareavailable.Theyshouldstandbywhenyoutraveltothebathroom,andgetyourassistivedevicestohelpyouwalk.Theyshouldhelpyougetyourrestandavoidunnecessarydistractions.

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Minimizingyourpain(fromthedayaftertotwoweeksaftersurgery)Painordiscomfortusuallydecreasesgraduallyoverthesixweeksaftersurgery.Itisimportanttotakethepainmedicationsregularlyasprescribed,andwhenthepaininterfereswithyourrest,mood,appetite,ordailyroutine.Restoftenanddonotpushyourselfbeyondyourlimits.Practicerelaxationtechniquessuchasdeepbreathing,imagery,andlisteningtomusic.Ifyoufindthatyourexercisesarepainful,takeyourpainmedication30minutesbeforeexercisingorgoingforphysicaltherapy.Watchoutnottosnagyoursurgicalpins(ifyouhavethese)onyourclothingorbedlinen–itwillhurt!Painmanagementprescriptions:Usually,tomanagethepain,yourdoctorwillgiveyouaprescriptionformedicationsthatwillhelprelieveyourpainduringrecovery.ThesemostcommonlyareplainTylenol(1-2tabletsevery4-6hourswhileawake),orNorco/Hydrocodone.SideeffectsofNorcoincludenausea,dizziness,orconstipation.OverthecounterconstipationmedicationsuchasColace®isrecommendedtohelpwithconstipation.Whatifyourpainisnotverywellcontrolled?

Assess-Canyoufeelyourtoes?Arethenailbedspink?Wereyouup?Howlongwereyouupwithyourfeetbelowyourheart?Wheredoesithurt?Howmuchdoesithurtonascalefrom1(verylittle)to10(worstpain)?

Whatcanyoudo?ElevateyourfootTakeyourpainmedication

Reassess-Ifyouarestillnotcontrollingyourpain,calltheclinicwithyourname,dateofbirth,andbestcallbacknumber.*Ifyouneedemergentattention–gotonearestEmergencyRoom

Reducingtheswelling:Itisnormaltohaveswellinginyourfootandankleaftersurgery.Raiseyourentirefootabovethelevelofyourheart(nomorethan6inchesabove)andgentlypumpyourfootortoesupanddownifable.Reducingtheswellingwillalsohelpyouregainmotioninyourkneeandcontrolofyourthighmuscles.Caringforyourincisions:DoNOTsoakyourincisioninwateruntil1weekafterhavingyoursuturesremovedatyourfirstpostoperativevisit.Donotapplyanycreamsdirectlytotheincisionduringthistime.Thesutureswillberemovedapproximately2weeksaftersurgery.Occasionallythereisasmallamountofoozingfromthewoundafterthesuturesareremoved.Exposethewoundtotheairorapplythin,sterilegauzedressingifneeded.

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Checkyouincisiondailyforsignsofinfection.Clarifywithyoursurgeonwhenyoucangetyourfootwetandwhoshouldchangethedressings.Checkingforpossibleproblems:Someoftheproblemsdescribedintherisksofsurgerysectionabovemayoccurafteryouhavebeendischargedfromthehospitalorsurgerycenter.Itisveryimportanttocontinuecheckingforsignsofinfectionandbloodclots,andtobringanyconcernstoyourhealthcareteam’sattention.Constipation:Thecombinationofpainpills,dehydration,andimmobilityaftersurgerymaycauseconstipation.Missingabowelmovementforoneortwodaysisnotuncommon,buttrytobeproactivetopreventsevereconstipationandpain.

• Keepwellhydrated(drinkfluids)• Eatlotsoffiberandfruit• Changetonon-narcoticpainmedicationslikeTylenol• ContinuetouseColaceearlyon(stopifloosestoolsresult)

Post-surgicalactivity:Manyfootandanklesurgerieswillrequireaperiodofnon-weightbearing,soyoucouldbenon-weightbearingaftersurgeryfor6-12weeks.Youwillbegivenspecificinstructionsatthetimeofyourdischargefromthehospitalastowhentobeginweight-bearing.Duringyourfollow-upvisits,yourhealthcareteamwilltellyouwhenitissafetoputweightonyoursurgicalfoot.CallorseeyourhealthcareteamIMMEDIATELYif:

• Swellingcontinuestoincrease,despitethefootbeingelevated.

• Painworsensinspiteoftakingyourpainmedication

• Yourtemperaturegoesupformorethan4hours(over101.5°F)

• Youdevelopchestpainsorshortnessofbreath

• Youdevelopnumbnessinyoursurgicalfoot

• Youdeveloppainandtightnessatthebackofyourleg

• Occasionally,toomuchswellingcanoccurandthiswillaffectthenervesinyourfoot.Ifyourfootremainsverysore,orifyoudevelopnumbnessinyourtoes,evenafterkeepingitelevated,contacttheclinicorgototheurgentcarelocatedinourWaconiaoffice.

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Follow-upappointmentsAssoonasyougethomefromsurgery,ifyouhavenotalreadydoneso,contacttheclinicforyourfollow-upappointments.Dependingonyourlocation,itmaybemoreconvenientforyoutobeseenattheWaconiaProfessionalbuildingclinicortheChaska212Medicalcliniclocation.Thefollowingiswhatyoumightexpectatyourpostoperativevisits.Visit#1:Approximately2weeksfromyoursurgerydate

ExaminationbyPhysicianAssistantSplintremovedX-raysorderedandreviewedSuturesremovedandSteriStripsappliedNewCAMBootorCastapplied*Forgastroc/hardwareremovalprocedures–progresstoshoeduringthedayStartphysicaltherapyifindicated

*ROM(Rangeofmotion)exercisesshouldbedoneifyouhavebeeninstructedtodothem.TakeoffthebootthreetimesadayforROMexercises,anddo30repetitionsoftheexercisesforthejointsofyourfoot.Visit#2:6-7weeksfromsurgerydate

MDexaminationX-raystaken(nox-raysneededforgastrocproceduresorhardwareremoval)Physicaltherapyreferral*typicallybeginprogressiveweightbearingatweek7(20lbsofweightevery3days),maybelonger@surgeon’sdiscretion

Visit#3:12weeksfromsurgerydate

MDexaminationX-raytakenSeephysicaltherapistfortransitiontoregularshoe*possiblyjustbeginningprogressiveWeightBearingdependingonprocedure.Discusspossiblehardwareremovalin3months

*Recoverytime Itwilltakethreetosixmonthsbeforeyoufeeladefiniteimprovementinthecomfortofyourfoot.Theswellingmaytakeoverayeartosettledown.Therangeofmotionmayalsotakeoverayeartoimprove.

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Follow-upfootcareandassistivedevicesFootcareandsupportiveshoesTopromotehealingofyourfootandtomaintainfoothealth:

o Keepyourfootcleananddry,andyourskinsoft.o Inspectyourfeetforchangesonaregularbasis.o Weargoodwalkingshoesonceyoursurgeonhasapprovedswitchingtoregular

shoes.HowtochooseasupportiveshoeThesinglemostimportantaspectofashoeistohaveitprofessionallyfitted.Makesuretheshoehas:

o Tielacingwithseveralholestosecurethefootsnuglyintheshoe,andtoallowforswelling.

o Sufficienttoewidthanddepthtoaccommodateyourfootcomfortably.o Afirm,wellfittingheelcounterwhichextendsintothearch.o Itisnotunusualtohavetoreturntothewalkingbootforshortperiodsoftime

whiletransitioningtoshoes.

PhysicaltherapyandrecoveryexercisesDuringthepostoperativecourse,youwillbedirectedonappropriatetherapyforrecovery.Lateryourprogramwillincludeexercisestostrengthenyourlegmuscles.Additionalexerciseswillbegiventostretchtightmusclesandothertissues,especiallyyourhamstringandcalfmusclesthatattachatthebackofyourknee.Yourbalanceandproprioception(awarenessofjointposition)willbepoorafterthesurgeryandwhilethereisswelling.Someexerciseswillhelptorestoreyourconfidenceinyourfootanddecreaseyourriskoflosingyourbalanceorfalling.Ifyoucontinuetohaveproblemswithyourwalkingpattern,thetherapistwillgiveyouexercisesandsuggestionsonhowtoimproveit.Wheneverpossible,theexerciseswillbefunctionalanddesignedtoaddressyourindividualneedsforselfcare,homecare,mobility,andleisureactivityneeds.Ifyouhaveconcernsaboutyourabilitytodospecificdailyactivities,talktoyourphysicaltherapist.OutpatientPhysicalTherapyisn’tusuallynecessaryuntil7weeksaftersurgery.Theremaybeexceptionssuchasagastrocrecession.Pleaseaskyourtherapistabouttheguidelinesforthisprocedure.

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Therapyguidelinescanbefoundonourwebsite:

www.tcomn.com/physicians/scott-holthusen

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Livingwithyourreconstructedfoot/ankleReturntoworkReturnstoworktimesvaryforfootandanklesurgicalpatients.Itdependsonyourjob,theoperationperformed,andhowmuchpainandswellingyouhaveaftertheoperation.Insomecasesyoumayreturnafteraweek;forothersitmaytakesixweeks.Insomecasesthesurgerywillnotallowyoutoreturntoyourprioroccupation.Herearesomethingsyoushouldconsideraboutreturningtowork:

• Canyouworkwhilenotbearingweightonthefoot?Ifso,painwillbethemainlimitingfactor.Itisunlikelythatyouwillbeabletoreturntoworkforatleast2weeksafterthesurgery.

• Ifyouhavetobearweightonthefootandyouhavehadafusion,itwilltake

youthreemonths,minimum,tobeabletobearweightonthefoot.Itwillusuallytakesixweeksafterthattobecomfortableenoughtoreturntowork.Ifthepainisslowtogoaway,itmaytakelonger.

• Ifyoudevelopanonunion(thebonesaretakinglongerthanusualtojoin),

thenitmaytakeuptoayearoffworktorecoverifthesurgeryhastoberepeated.Thiscouldbeacomplicationresultingfromsmoking.

• Discussthetimingofthesurgerywithyouremployerandyoursurgeon,who

maybeabletochangethetimeofyoursurgerytoaccommodateyourworkschedule.

• Pleasehaveyourdisabilityformsandpaymentsreviewed,completed,and

approvedbeforeyoursurgery.Makesureyouknowwhatyouareeligibleforunderyourinsuranceorothercoverage.Ifyouhavepaperworkspecifictoyouremployment,ordealingwithworkerscompensationorotherinsurancerequirements,pleasebringthiswithyoutoyourappointment.

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ReturntodrivingDependingonyoursurgery,youwon’tbeabletodriveforabout12weeks.Youwillbeabletodrivesoonerforleftfootsurgeries.Yoursurgeoncannotclearyoutodriveduetolegalrestrictions.After12weeksyoushoulddemonstratetoafriendorfamilymemberthatyoucansafelydrive.AirportsecurityandyourfoothardwareThehardware(screwsandplates)inyourfootorankleshouldnotsetoffthesecuritysensoralarmsasyoupassthroughairportsecurity.However,ifthisdoeshappen,showthesecurityofficerthescarsfromyoursurgeryandtheywillcheckformetalwithahand-heldmetaldetector.Anidentificationcardsignedbyyoursurgeonisnolongerrequiredbyairportsecurity.Ifyouhavequestionsaboutairportsecurityscreeningmatters,contacttheaircarrieryoutravelwith.AntibioticsfordentalworkAntibioticsfordentalworkarerequiredforsomepatientswithtotaljointreplacementsandcanbearrangedthroughouroffice.RecreationalactivityguidelinesInmostcases,itwilltakeawhileforthefoottofeelcomfortableduringstrenuousactivities.Apartfromminorsurgery(suchasanklearthroscopy)itwilltake4-6monthsforyourfoottofeelcomfortabledependingonsurgeryandtheactivity.