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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.