Care of the Post-Op Foot Surgery Patient

By Anne Eby, RN, ONC, BSNNursing made Incredibly Easy! November/December 20082.0 ANCC/AACN contact hoursOnline: www.nursingcenter.com

© 2008 by Lippincott Williams & Wilkins. All world rights reserved.

Foot Surgery

Includes a variety of procedures:

Removal of a growth Amputation of part or all of the foot Elective or emergent procedures for

musculoskeletal disorders

Nonsurgical management remains the treatment of choice for chronic foot disorders

When these options fail, surgical treatment may be necessary

Anatomy of the Foot

The foot contains: 26 bones 33 joints More than 100 ligaments, tendons, and muscles

Joints and muscles of the foot allow for a wide range of motion

Components prone to injury: Achilles tendon Plantar fascia ligament

Two most commonly discussed arteries: Dorsalis pedis Posterior tibial

Anatomy of the Foot

Common Foot Deformities

Bunions—a local painful swelling caused by misalignment of a joint

Clawfoot—an abnormally high arch and a fixed equinus deformity of the forefoot; Charcot foot deformity is a common cause

Clubfoot—one or both of the feet turn inward; effects 1 in 1,000 newborns

Flatfoot—progressive disorder in which the arch of the foot is diminished; four times more likely in women; causes: congenital abnormalities, injury, muscle fatigue, obesity, hypertension, diabetes, or arthritis

Common Foot Deformities

Hammer toe—flexion deformity of the interphalangeal joint

Heel pain—usually related to inflammation of the plantar fascia or entrapment of the medial calcaneal nerve or the first branch of the lateral plantar nerve

Morton’s neuroma—swelling of the third branch of the median plantar nerve caused by ischemia of the nerve from compression or trauma

Picturing Common Foot Deformities

A Closer Look at Charcot foot

Treatment

Bunions X-rays to determine the extent of deformity Ranges from no treatment to orthoses or night

splints

Clawfoot Exercises and bracing

Clubfoot Managed exclusively with the Ponseti technique,

which involves stretching the foot, casting, and tenotomy, followed by wearing braces

Treatment

Flatfoot Exercises and orthoses, surgery if necessary

Hammer toe Wearing open-toed sandals and performing

manipulation exercises; osteotomy may be required

Heel pain Corticosteroid injections, taping ,and casting;

surgery when conservative treatment fails after 6 to 12 months

Morton’s neuroma Inner soles and metatarsal pads to balance foot

posture, local hydrocortisone injections

Post-Operative Care

Depends on type of injury and procedure

Nursing care focuses on:

Promoting tissue perfusion Pain management Preventing complications Improving mobility

Promoting Tissue Perfusion

Assess the neurovascular status of the affected extremity every 1 to 2 hours for the first 24 hours, including:

Color Edema Temperature Pain Capillary refill time Sensation Pulses Motion

Indicators of Neurovascular Dysfunction

Circulation Pale, cyanotic, or mottled color Cool temperature Capillary refill time of more than 3 seconds

Motion Weakness Paralysis

Sensation Paresthesia Unrelenting pain Pain on passive stretch Absence of feeling

Pain Management

Related to inflammation

Elevation and ice

Oral or I.V. pain medications

Assess your patient’s pain by asking her to identify its location, describe its quality, and rate its intensity

Preventing Complications

Most significant are infection and deep vein thrombosis

Prophylactic antibiotics

Pin care (if applicable) with stringent standard precautions

Early mobilization, compression devices, and anticoagulants as appropriate

Improving Mobility

Weight bearing as tolerated/ordered

Use of assistive devices, such as crutches or a walker

Patient teaching in safe use of these devices

Teaching Crutch Maneuvering Techniques

To sit down Grasp the crutches at the hand pieces for control Bend forward slightly while assuming a sitting

position Place your affected leg forward to prevent weigh

bearing and flexion

To stand up Move forward to the edge of the chair with your

strong leg slightly under the seat Place both crutches in your hand on the side of the

affected leg Push down on the hand piece while raising your

body to a standing position

Teaching Crutch Maneuvering Techniques

To go down stairs Walk forward as far as possible on the step Advance the crutches to the lower step, advancing

your weaker leg first and then the stronger one

To go up stairs Advance your stronger leg first up to the next step. Advance the crutches and then the affected leg A helpful memory device for your patient is: Up with

the good, down with the bad

Tripod Position for the Basic Crutch Stance

Self Care After Foot Surgery

Signs and symptoms to report

Change in sensation Inability to move your

toes Toes or foot cool to the

touch Color changes

Pain management Elevate your foot to

heart level Apply ice as prescribed Use analgesics as

prescribed Report unrelieved pain

Mobility Use assistive devices

safely Comply with prescribed

weight-bearing limits Wear a special

protective shoe over the dressing

Wound care Keep the dressing or

cast clean and dry Report signs of

infection, such as pain, drainage, or fever, immediately

Follow the prescribed antibiotic regimen

Keep your appointment with the surgeon for the initial dressing change