Background
For your surgery you will be seen by a surgeon or a specialist podiatrist, who will go through your operation with you in detail.
What are the benefits of surgery?
You discussion with the specialist will include the benefits and anticipated recovery times but the main benefit of surgery will be to improve your quality of life. Please ask questions if you are unsure. A number of patient information leaflets on specific operations will be available soon.
Your inpatient pathway
There are 6 stages to your inpatient journey with us
- Referred to Fife Orthopaedics by your GP, you and your consultant decide that your best option is surgery.
- Are you fit for surgery? Attend for your pre operative assessment appointment.
- As an inpatient, you will have your surgery at the NTC.
- Stay 1-3 days at the NTC getting ready to recover fully at home.
- At home, help speed up your recovery by doing all recommended physiotherapy.
- Come and see us for your check up after 6-12 weeks.
Your operation
There are many different types of foot and ankle surgery and your surgeon will discuss the best option for you.
How do I prepare for my operation?
There is growing evidence to support the benefits of getting into the best health before you undergo surgery. It is a good idea to do as much moderate exercise as your pain will allow but in particular make sure that you do a pre-surgery exercise that you were given at your pre surgical appointment or call. If you smoke, stop smoking as your chest needs to be clear for your anaesthetic. Drink only moderate alcohol. It is worth ensuring that you eat well in the days and weeks ahead too to speed up your recovery. You can read more about how to get ready for surgery using these links.
After your surgery
Following surgery, you will need to follow instructions, perform appropriate exercises, and change your activities during your healing process. This requires patience, persistence, and a desire to get better. If you are unable to complete these instructions, it could affect your results and you should consider alternative treatments that do not involve surgery. If you feel that surgery is not currently for you, it is important that you make this clear at an early stage. We want you to achieve the best outcome possible.
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Pain management
A local anaesthetic nerve block may be offered to you and performed at the start of surgery. This will produce numbness around the nerves in the region of your procedure. It will provide you with pain relief for approximately 12-18 hours after surgery, enabling you to be more comfortable in the early recovery period. It will also allow time to take some of your tablet painkillers prior to the block wearing off and prevent a sudden onset of pain.
It is best to take your painkillers regularly for the first 1-2 weeks. These will be either provided to you or recommended by the anaesthetist following your operation. It is also worthwhile taking pain killers prior to your first post-operative visit to ensure that any plaster and/or suture removal is as comfortable as possible.
Dressings and external pins
You should not remove your dressings and/or plaster cast until your first post-operative appointment, unless specifically directed by your surgeon to remove before. This minimises the risk of infection and wound healing issues. The dressings must stay dry when washing. There are waterproof bags that can be purchased in shops or online to help with this. They are not routinely provided by the hospital.
If part of your wound oozes blood onto the dressings, adding further padding is advised. This in combination with elevation and application of an ice pack (or frozen peas!) is usually all that is required. If this does not stop the bleeding, or if you are concerned after surgery please contact the Orthopaedic advice line on 01592 643355 (Extension 22685) or your GP surgery. If the wound becomes red or inflamed we would usually want to see you earlier than your scheduled appointment. Again, please phone the advice line.
If you have any external pins in your toes, they can sometimes get knocked, which can be uncomfortable. If the pins fall out, please let us know, but it is very uncommon to have to re-do the operation in this situation. Rarely, the pins can become painful and/or infected and require a short course of tablet antibiotics.
Swelling
Swelling often increases over the first 6 weeks and then usually reduces over the next 6 weeks. Depending on the nature and extent of the surgery, it may take up to 12 months to settle. This is the normal way the body heals. Rest and elevation, wherever possible is helpful, especially in the first few weeks after your operation. As the foot swells it is common to have some stiffness and mild nerve pain (pins and needles/electric shocks), which usually settle as the swelling improves.
Excerise
While you are resting it is important to perform gentle range of motion and strengthening exercises. This promotes blood flow, allows muscle strengthening, and reduces stiffness. The exercises given to you by your surgeon or physiotherapist are designed to help with recovery and to gain the best results after surgery. However, do not over do it. Too much too early can be just as bad as not doing enough. This includes sport. Your surgeon or physiotherapist will give you a realistic timeline of recovery ahead of your surgery.
Risks and complications
Fortunately complications are uncommon. However, they do occur and you need to be aware of them. The following is a non-exhaustive list of some of the more frequent ones. You should also be aware that several factors can increase your chance of having a complication. These include smoking, diabetes, and obesity. You can reduce this risk by quitting smoking, good blood sugar control, and losing weight ahead of surgery.
Infection
This occurs when the wound is invaded by bacteria, usually from your surrounding skin. Signs you may have an infection include heat, tenderness, unusual fluid, or a bad smell coming from your wound. You may also have a temperature or feel generally unwell. Most infections can be treated with tablet antibiotics. More serious ones require admission to hospital and further surgery to clean out the wound, but this is thankfully uncommon.
Wound healing
Normal wound healing requires good blood flow. Being too active early after surgery causes bleeding and swelling which can cause part of the wound to open. The foot is very delicate in this respect. It is important that you rest and keep your foot elevated as much as possible for the first 10-14 days to encourage healing.
Nerves
Nerves are the electrical system of the body. It is extremely rare for nerves to be cut but nerves are commonly affected by swelling after surgery. This can cause partial numbness and sometimes, a burning pain or pins and needles. This generally resolves as the swelling improves, but can take many months.
Stiffness
Both injury and surgery create scar tissue. Some people are prone to developing excess scar tissue. When this is combined with swelling after surgery, it may lead to stiffness. Most of this can be addressed through good quality physiotherapy and your own involvement in recovery. This can take many months and patients can find this challenging.
Bone healing
Surgeons can only create the environment for bone healing. It is your body that performs the final joining process. This can fail if there is too much mobility (i.e. you walk on it too early) or if there are blood flow problems or infection. If the bone fails to heal it may require further surgery. This is called a non-union. We know that smoking, poor blood sugar control and certain medications can increase this risk.
Deep vein thrombosis (DVT) & pulmonary embolism (PE)
These, fortunately, are rare events but can have serious consequences. Signs you may have a DVT include swelling that does not improve with elevation of the leg, colour changes, calf pain or tenderness. Signs you may have a PE include chest pain or shortness of breath. Seek immediate medical attention if you are concerned about either of these.
Make sure you tell a member of the surgical team if you, or a close family member, have ever had a DVT or PE in the past.
Prolonged or excessive pain
This can be a sign of a variety of complications following surgery, with many mentioned previously. On very rare occasions a chronic regional pain syndrome (CRPS) can develop in addition to these and require prolonged management with specialist medications and physiotherapy. The recovery from this can sometimes take up to two years.
Anaesthetic (general, spinal, nerve blocks)
Any concerns should be discussed with your anaesthetist when they review you before your surgery.
Going home
We understand that most people wish to recover at home. You can go home when your pain is under control and you can get around safely and any care you require is in place. See our post surgical issues page for where to turn to if you think you need help post-surgery.
You must follow any advice given by the team and be prepared for using walking aids until you can walk without. All patients will receive a discharge letter and one will also be sent to your GP.