Elective Foot Surgery
An explanation of the surgical process and what you can expect from start to finish.
The surgical process can seem very complicated and scary. Although it is normal to experience apprehension with this process, a little information and reassurance can help make your surgical experience easier.
The decision to choose surgery has not come lightly. Your surgeon has considered the effectiveness of non-surgical treatment options for your condition. The decision for surgery usually comes when non-surgical therapy is not helping sufficiently, and you have either exhausted your non-surgical options or you have elected to undergo surgical care. Some conditions do not have effective non-surgical options, and require surgery for the best chance of recovery. Your surgeon has reviewed your treatment options at this point, and together you have decided to pursue surgery. Your surgeon believes this is in your best interest for recovery, and has considered your health and safety in the surgical and recovery process. Your surgeon has taken into account the potential complications that may be encountered during your surgery, and has explained them to you during your surgical consultation.
The Week Before Surgery
The week prior to your surgery is a very important one. During this week, you must prepare your home and your life for the upcoming recovery process. If you have limited help, you need to spend this time preparing for issues that normally would not arise, such as ensuring you have adequate transportation to and from the surgery center, to your surgeon for follow-up appointments, as well as for any emergent unexpected need. If you are having surgery on your right foot or if you drive a manual transmission vehicle, it is not recommended you drive post-operatively until cleared by your surgeon. Keep in mind it is also imperative you not drive yourself to and from the surgery center on the day of surgery, as the anesthesia and general effect of the act of surgery itself makes it dangerous for you to drive yourself home. Other factors to consider when preparing for surgery during this week is ensuring a well stocked kitchen to avoid the need to grocery shop, completion of all immediate errands and tasks at home and work, as well as an adequate supply of games and entertainment to make the first week at home pass by quickly. The first week of recovery should be spent doing just that, rather than worrying about the other details of life.
It is also advised that during the week before surgery you should fill all post-operative medications to have available immediately upon return from the surgery center. Any other prescription medications you may be running low on should be filled in case you have difficulty obtaining them during recovery. Be sure to discontinue any medications your doctor has requested you discontinue prior to your surgery. Failure to do this may result in a cancellation of your surgery that morning as certain medications pose a danger to the surgical and recovery process.
The Morning Of The Surgery
The morning of the surgery (and by extension the night before) can be extremely stressful, and scary as well. This is especially true if you have never had surgery before, or are having a major operation. This is perfectly normal. There are some steps you can take to ease this anxiety. It is of vital importance that you have a well balanced, nutritious, and filling meal the evening before the surgery. Make sure you go to bed early, and get plenty of healthy sleep. If you have lingering concerns or doubts, it is perfectly acceptable to call your surgeon with your questions or concerns. You will not be the first to have these concerns, nor will you be the last. Your surgeon is the best person to answer your questions and help with your concerns about the surgery to the fullest extent. Try to avoid distractions to sleep the night before, such as exciting movies or television programs, and if applicable have a spouse or family member/friend help with children or pets that night.
It is very important to get up on time in the morning for two reasons. Firstly, the less you have to rush to arrive on time to the surgery center, the less stressed and anxious you will be. Secondly, you obviously must arrive on time to have the surgical staff prepare you for the surgery adequately. Often this will be very early in the morning. If you arrive to the surgery center late, even if it is technically before your surgical start time, the staff may not be able to prepare you adequately enough to stay on time. This will force your surgeon to cancel your case, as it will cause delay to all the other surgeons to follow your surgeon in that operating room.
Once you arrive to the surgery center, you will have to check in with a reception or registration desk depending on the facility. They will obtain more information about you and will verify your insurance, or review payment plans if you are uninsured. There may be paperwork to fill out and sign during this time as well, and you will sign a consent for the surgery center to provide you with care during the surgical process. You will then be asked to change into a hospital gown, and your possessions will be collected and held safe. Depending on the surgical center, at least one member of your family will usually be allowed to accompany you during the entire process leading up to the actual surgery. The staff will place you in a comfortable pre-operative room or bed, where they will take any labs ordered by your surgeon, including an EKG if appropriate. An IV line will be started so medication and fluids can be given throughout the surgical process. This may be briefly uncomfortable as it involves a small needle, but it is vitally necessary and the process will be over in under a minute. At some point, you will meet your anesthesiologist, who will discuss all your options for anesthesia, as well as the risks associated with this. Your anesthesiologist will have previously reviewed your medical information, and will be aware of any health conditions that may make one form of anesthesia better than the other. However, he/she may need to ask more questions to make the best decision possible on what to give you. If you are simply having a minor case with local anesthesia (numbing) by your surgeon, or if your health is too poor for other forms of anesthesia, you will not see an anesthesiologist.Your surgeon will eventually meet with you to review your surgery, ensure all your questions are answered, and reinforce your post-operative instructions so you may have an uneventful recovery. At that point, barring any problems with your pre-operative labs or studies, you will be taken to the operating room.
The Operating Room
Once you are in the operating room, you will be moved onto the operating table. Most foot surgery is performed with you on your back, so you will lie on the table facing upwards. This table is very narrow, so care must be taken to ensure you do not slide off it. The operating room staff will assist you with positioning, and will then apply a strap around your waist to keep you in place. Since the table is narrow, you may not be able to lay your arms on the table, so therefore an arm board on either side of your body will be used to position your arms comfortably. During this time, several people will be attending to you at once, and it can seem kind of hectic. The nurses will be placing blood pressure cuffs and a device to monitor your blood oxygen on you, as well as any pads or protective devices for use during the surgery. Your surgeon may be applying padding and a tourniquet device to your ankle or thigh. The anesthesiologist will be preparing you for the surgery, and injecting medications to help you fall asleep. All the while, you will be breathing oxygen through a nose tube or a mask. Once the anesthesiologist is ready, he/she will then start your anesthesia and your surgeon will numb your foot with a local anesthetic, which you should not consciously feel. If you are only having local anesthesia, there will be no anesthesiologist during this process. You will feel the sting of the local anesthetic medication when your surgeon is ready to inject your foot, and numbness of the foot or part of the foot will soon follow.
If the site of your surgery requires you to be lying down (such as surgery on the back of the heel), you will not be moved from the gurney that transported you into the operating room until the anesthesiologist has started your anesthesia. The staff will then roll you onto your stomach onto the surgical table once you are under general anesthesia. Sedation anesthesia is usually not performed if you have to be positioned on your stomach during the operation as your airway will not be well protected. General anesthesia with the protection of an airway tube is necessary. After you are positioned, all the other preparation for the surgery as mentioned above will be performed by the operating room staff.
The staff will then scrub your lower leg with an antiseptic soap and apply sterile drapes over your body. The surgeon will scrub his hands and arms with an antiseptic soap or lotion, and will start the surgery. If a tourniquet is used, it will be inflated at this time over the ankle or leg in order to keep too much fluid from obscuring the surgeon's view of the surgical site once the incision has been made. During the surgery, the anesthesiologist and operating room staff will monitor your vital signs to ensure your health and safety as the surgery progresses.
Once the surgery is completed, sterile bandages will be applied to your foot, and any splint or cast needed for recovery will be placed on the leg following the bandaging. The anesthesiologist will then reverse your anesthesia, and the staff will help move you back onto the gurney for transportation to the recovery area. You will slowly wake up in this place, which, depending on the facility, may be the same room you prepared for the surgery in. If you only had a local anesthetic, you will be completely awake from the start. Sedation anesthesia takes a little longer to wake up from, and general anesthesia takes the longest. The recovery staff will ensure your vital signs are stable, and will make sure you are not in any pain. The local anesthetic you received in the operating room will last several hours at the very least, but you may have break-through pain. The nurses can give you pain medication at this point in time if your surgeon allows. Before you are considered fully recovered from surgery, you must be able to perform several tasks, including swallowing, breathing well on your own without the assistance of oxygen, and the ability to urinate. Once you are fully awake and alert, and once your body can perform these simple tasks, you will be considered recovered from surgery and your family will be able to meet with you. If time permits, your surgeon will have already talked to your family or those accompanying you to the surgery center regarding how your surgery went. If you wake up quickly enough, your surgeon will also be able to talk to you and discuss the surgery. Post-operative instructions will be repeated as well if you are awake enough to discuss them again. Shortly after your full recovery, you will be allowed to redress and will be transported in a wheelchair to your car.
The Ride Home
Many people take the ride home for granted. Although this is certainly an uneventful time, one important task needs to be performed to ensure a comfortable first night. It is of vital importance to keep your foot elevated in the back seat during the ride home. This is especially true if your commute time is more than fifteen minutes. If your foot dangles on the floor of the car, gravity will push all the fluid that is already building up in preparation for the healing process into the foot and lower leg, causing eventual throbbing pain from excessive inflammation. Elevating the foot during the ride home and during the recovery process will help limit this common cause of post-operative pain.
The First Night
There is usually no way around this: the first night following your surgery is nearly always uncomfortable in the least. Your body responds to the injury of a surgery by starting a complex chemical process that attracts a lot of fluid and healing chemicals to the site of the operation. In addition, microscopic nerves cut during the incision process are also sending pain signals to your brain. All this combined can make for a very uncomfortable first night after surgery. The key to controlling this and bringing pain down to a tolerable level is to keep your foot iced and elevated as instructed by your surgeon, and to take prescribed pain medications as directed (but no more to avoid overdosing on the pain medication or the Tylenol usually in it as well). If you have done these things, but still have intolerable pain, you should call your surgeon for advise. He may suggest alternate techniques to reduce your pain, or may call in a stronger medication for you to take. Don't be afraid to call him if you are having problems in the middle of the night, as your surgeon wants to hear of any recovery problems no matter what the time is in order to help you feel better. This is especially true if you are experiencing any nausea, vomiting, fever, chills, shortness of breath, or chest pain.
Due to your anesthesia, your sleep cycle may be disrupted. You may have difficulty falling asleep, or you may have difficulty staying asleep. Either way, try your best to ensure you have a quiet environment in which to attempt sleep, as your body needs rest in order to heal.
The First Week
Over the course of the first week following surgery, your pain and discomfort will gradually decrease as the inflammation cycle your body is in comes to a close. By continuing to keep your foot iced and elevated, and limiting your activity, your foot will begin to feel better and you will develop more energy. It is during this time of improved energy that you must be vigilant not to become overactive. While your body may feel better during this time, your foot still needs rest and recuperation. A common mistake for recovering patients is to begin an attempt at near-normal activity too early. It is important for you to follow your surgeon's specific recovery instructions to avoid difficulty later on in the recovery process. This includes the use of a protective post-operative shoe or boot as necessitated by your specific surgery. If you are in a cast or spilt, you must be careful not to place any weight on the foot in question, as this could reverse the gains made by your surgery and lead to further complications. Crutches, a Roll-A-Bout, or a wheelchair will have been arranged for you prior to your surgery to help you keep weight off of a cast or splint. Use these devices exactly as instructed by your surgeon.
It is imperative you keep your dressing dry, clean, and intact. Failure to do this could result in an infection, as water and dirt can expose your incision to bacteria which can quickly enter the skin through the healing tissue. When bathing, a sponge bath is best, followed by bathing in a tub with one's foot out as the next best technique. If you must shower, it is vital you use a commercial grade shower protector, as contraptions like duct tape and a plastic bag nearly always fail.
The First Follow-Up Appointment and Beyond
Within one to two week's time, you will be required to return to your surgeon's office for a post-operative evaluation. Depending on the length of time since your surgery, and depending on whether your incision has healed properly, your sutures may be removed at this first visit. Although most people experience little to no discomfort during this removal, it is still advisable you take one of your pain medications two hours prior to this appointment just in case. Your dressing will be changed, and must remain intact and dry until your surgeon advises otherwise. If part of your surgery involved bone, x-rays will be taken to see how well you are recovering internally, and to confirm your correction. Your surgeon will discuss with you any continuing instructions for your care at home, and if necessary will give you new instructions. Any complications (though uncommon after a typical foot surgery) will be dealt with if not already identified and addressed prior to your first follow-up visit. This can include further lab tests, imaging, or medication use such as antibiotics. It is important that you discuss with your surgeon any concerns about your recovery, as the typical recovery should be relatively uneventful except for the moderate pain as discussed earlier.
From this point onward your recovery will continue with periodic follow-up visits until your surgeon discharges you from post-operative care. This point can vary based on your specific surgery, as well as your rate of recovery. For the most part, surgery involving moving or fusing bones take six to eight weeks to heal, while surgeries involving soft tissue will take three to six weeks to heal. There are exceptions to this, of course, and your surgeon will advise you regarding your specific case and recovery rate. Your surgeon will direct you as to how quickly you can return to full activity, if there are any temporary or permanent restrictions on that activity, and what style of shoes you should ultimately transition into.
Once your surgeon feels you are fully healed and have a fully functional foot, you will be discharged from post-operative care. This may be several months after your surgery, as he may want to ensure your intended results are properly and fully achieved.
While the surgical process is stressful and full of uncertainty, you may rest assured that your surgeon has your comfort and best interest in mind with every facet of the surgical period. Following his instructions will not only allow you to recover faster, it will also give you the benefit of his experience and the experience of all the successfully treated patients that came before you. Through understanding of the process as a whole and the focus of your part in it, you will successfully heal and restore function back to your foot.
Checklist Of What To Do The Day Before The Surgery
- Starting eight hours before your surgery, eat or drink nothing.
- Consult your surgeon's list regarding what medications should be stopped before surgery and what can be taken the day of surgery.
- Make sure you have filled any post-operative medication prescriptions.
- Remove all make-up and nail polish.
- Get a good night's sleep.
- Wake up early enough not to rush to get ready.
- Wear comfortable and loose fitting clothing.
- If you have been given crutches, bring them to the surgery center.
- Be on time for your instructed arrival to the surgery center.