After Surgery

Dr Jeff Ling

Swelling

Prolonged swelling is a real hallmark of foot and ankle surgery. It represents the after-effects of increased blood flow to the area for healing, and the body’s evolutionary instincts to protect an injured area by padding it out with fluid. Swelling will go up and down according to activity and how long you remain upright with the foot hanging down.

Bear in mind that whilst swelling is normal, too much swelling can cause discomfort and the best strategy to reduce swelling are natural remedies such as rest, elevation, and ice. Keeping the “toes higher than the nose” will aid in returning fluid to the heart and help decrease swelling and pain. NSAIDs such as Neurofen and Celebrex have an anti-inflammatory effect and can also reduce swelling as well as pain.

Pain Relief

Jeff and his Team will provide you effective strategies to ensure the post-operative period is manageable and comfortable. Your anaesthetist will perform a regional block with local anaesthetic when you are asleep which means you will wake up with the operative site being numb and therefore comfortable. The block generally lasts 12 – 24 hours and then wears off. As this occurs, we will provide you a combination of opiate analgesia (Endone/Palexia/Targin/Morphine) and simple analgesia (Paracetamol and Celebrex). Please take your pain medicine as directed on discharge. In most cases, strong pain relief is not required beyond the end of the second week after surgery but regular simple analgesia is recommended until you are completely comfortable. You may experience odd sensations including intermittent burning, sharp jabs, and tingling. This too, is a normal part of the recovery and is due to the small nerves in the area just doing their job and letting the brain know something special has happened in that area! Most of the time, nerve symptoms if present, settle naturally after the first 2-4 weeks.

Reducing risk of blood clots – Deep Vein Thrombosis (DVT) and Pulmonary Embolism (PE)

All of our patients will have some degree of impaired mobility after surgery which is a risk factor for the development of a clot in the calf – deep vein thrombosis (DVT), bits of which can break off and lodge in the lungs – pulmonary embolus (PE).

Other risk factors include smoking, previous history, family history, and the oral contraceptive pill.

Generally speaking, if you are allowed to weight bear after your procedure – e.g. most forefoot procedures, arthroscopy, removal of hardware – you are considered low risk and we employ mechanical strategies in the form of ankle, knee, and hip range of motion exercises to encourage blood movement out of the veins of your legs and prevent clotting.

If you are non-weightbearing and in a cast, you are considered moderate risk. Jeff takes the risk of DVT/PE seriously and will generally use a prophylactic dose of Rivaroxaban (Xarelto) which is a small tablet taken once a day for the period you are non-weightbearing and in a cast.

Infections

Wound infections and breakdowns occur uncommonly after surgery. Unfortunately, they are slightly more common in the foot and ankle region due to many reasons including more limited blood flow, more swelling due to gravity, and a higher bacterial load. In the event of an infection, they tend to commence in the second week after surgery. Increasing pain, redness, swelling can be signs of infection. If you are concerned, please contact our office, your GP, or the hospital where you had your procedure and they will direct your enquiry. Please also see section “Emergencies & Concerns

Alcohol

Alcohol increases swelling and will make your natural swelling around the operative site even more pronounced. Additionally, alcohol impairs co-ordination, and impairs judgement, making you more likely to fall and injure yourself in the critical post-operative period. If you must drink, we recommend you limit it to one standard drink a day.

Daily Activities

Wound healing is the first goal, and moving around too much in the first 2 weeks can jeopardise this. We generally recommend strict elevation and bed or sofa rest for the first 72 hrs regardless of how minor a surgery you have had. For the remainder of the first 2 post-operative weeks or at least till your wounds heal, we recommend limiting the amount of time you are upright to necessities only. To help facilitate this, we recommend you do a pre-emptive shop and cook some meals beforehand. It is important to eat well after surgery with a high protein diet, as the building blocks of our body, whether it be skin, tendon, muscle, or bone, are made up of protein.

Arrange for others to help with everyday tasks like cooking, shopping and laundry. Put items that you use often within easy reach so you won’t have to reach and bend as often. Remove all loose carpets, keep floors dry, and tape down electrical cords to avoid falls. Jeff and his Team will talk to you in detail about this part of your recovery along the way.

Respite/Rehab

The vast majority of our patients will be discharged safely and comfortably to their home environment for recuperation after their procedure after daily assessment by the hospital physiotherapists during their stay.

Jeff and his Practice Nurse may sometimes recommend a period at a rehabilitation hospital for a period of respite or rehab. Reasons here include a tricky home environment e.g. lots of stairs, age or frailty, or if you are from out of town and needing to stay in Sydney for longer. The patient categories of “respite” versus “rehab” are somewhat arbitrary but can help determine whether a rehab hospital will accept you or not. Essentially, if you are allowed to weight bear after your procedure, you are more likely to be classified as a “rehab” patient and more hospital options are available. If you are unable to weight bear, a category in which many of our patients fall, and you are unable to go home safely to your home environment, we can still get you to a rehab hospital for a couple of weeks, but as a so-called “respite” patient.

Work

Confirm with Jeff and your employer how long you plan to take off work.

After a procedure, a minimum of 2 weeks off work can be expected to recover from the anaesthetic and to protect the wounds. This time can be truncated in some situations if light or “home-based” duties are an option. For those needing to get back to work as soon as possible and can also work from home, we still recommend you take at least 3-4 days off to focus on your recovery for minor surgeries and a full week off for more major surgeries.

After the 2 week wound check, if you perform office or desk-based work, you can return to the workplace providing you can sit with your foot elevated on a chair and you can get lifts into work. At this point, you may also drive yourself to work if the surgery is limited to your left side and your car is automatic. (See section below on “Driving after Foot & Ankle Surgery”)

Longer periods off work may be required if your work is of a physical nature, you need to take public transport to work, or if your employer requires “a full work clearance” before returning to full duties. It is important that you discuss this with your employer prior to surgery to avoid disappointment. Jeff’s team will email you a medical certificate on the day of your surgery.

Driving after Foot and Ankle Surgery

A safe return to driving after surgery is not governed by legislation but more by common sense. A safe return to driving depends largely on the procedure you have had, your individual driving ability and your recommended rehabilitation.

If your surgery is limited to the left side, then generally you may resume driving an automatic car with your right foot after the first post-operative wound check at 2 weeks.

A common-sense rule of thumb for safe driving is whether you can apply appropriate pressure with your right foot to stop your car suddenly in an emergency. Typically, an ability to weight bear with minimal pain is a good sign that this may be the case. In addition, you must be off all opiate medication.

Forefoot Surgery e.g. bunions, big toe arthritis, lesser toe corrections, neuromas 2 – 4 weeks If wires in situ, cannot drive till wire removed at 4 weeks<br /> Post-operative sandal cannot be worn whilst driving and a roomy shoe for driving must be used
Soft Tissue Reconstructions Achilles: 6 – 8 weeks<br /> Ankle ligaments and Syndesmosis: 3-4 weeks<br /> Accessory Navicula: 4 weeks Take boot off to drive, <br />drive with a roomy driving shoe or sandal; <br />re-apply boot when you arrive at destination
Bony Reconstructions Midfoot and hindfoot arthrodesis: 10 – 14 weeks<br /> Ankle arthrodesis: 8 weeks<br /> Flatfoot and Cavovarus reconstructions: 8 - 10 weeks
Ankle Replacements 4 weeks
Arthroscopy 1 – 2 weeks
Trauma e.g. Ankle fractures, Lis franc injuries 2 – 4 weeks after resume weightbearing

Do you still have a question about your recovery that has not been covered?

Jeff is continually updating and improving the information made available to his patients. If you feel that specific information may benefit future patients please email us at drjeffling@gmail.com.

Following surgery, there are multiple systems in place to ensure that you feel supported and protected. Click to learn more.

DR JEFF LING
Suite 31, Level 7
  02 9650 4782

DR DAVID LUNZ
Suite 29, Level 7
  02 9650 4835

Prince of Wales Private Hospital
Barker St
Randwick NSW 2031

8:30 am - 4:30 pm
Monday to Friday

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