Post-Operative Protocols

Most surgeries that are performed require a period of non-weightbearing and each specific surgery of the foot and ankle have a different recovery time. Bones take about 6-8 weeks to heal about 80% of their normal strength. Following a period of non-weightbearing, a patient progresses to partial weightbearing in a walking boot. Physical therapy and management of swelling is essential for a patients recovery.

Foot Standard Protocol #1

  • Bunion Surgery
  • Hammertoe Surgery
  • Weil Osteotomy
  • Excision Interdigital Neuroma
  • Excision Ganglion Cyst
  • Cheilectomy
  • 1st Metatarsal Fusion
  • Bunionette Surgery
  • Foot Hardware Removal

-You will be in a posterior splint following surgery. You will be nonweightbearing and will follow up to the office 5-7 days after surgery. Keep the postoperative dressing dry. Elevate and ice the leg for comfort. Your dressing will be changed and you will then be transitioned into a walking boot.

-This begins a gradual increase to full weight bearing in a walking boot as pain and swelling allows. The boot is taken on and off to shower and sleep. Range of motion is encouraged when the boot is removed when you are non-weightbearing. You will be given a compression stocking to help alleviate swelling.

-You will then be prescribed 4-6 weeks of physical therapy if necessary, which will increase your strength, motion and flexibility.

Ankle Procedures Standard Protocol #2

  • Ankle Arthroscopy
  • Hardware Removal
  • Ankle Synovectomy

-You will be in a posterior splint following surgery. You will be nonweightbearing and will follow up to the office 5-7 days after surgery. Keep the postoperative dressing dry. Elevate and ice the leg for comfort. Your dressing will be changed and you will then be transitioned into a walking boot.

-This begins a gradual increase to full weight bearing in a walking boot as pain and swelling allows. The boot is taken on and off to shower and sleep. Range of motion is encouraged when the boot is removed when you are non-weightbearing. You will be given a compression stocking to help alleviate swelling.

-You will then be prescribed 4-6 weeks of physical therapy if necessary, which will increase your strength, motion and flexibility.

Ankle Procedures Standard Protocol #3

  • Ankle Ligament Reconstruction
  • Ankle Arthroscopy with Repair of Osteochondral Defect
  • Tendon Repairs/Transfers
  • Ankle Fractures
  • Achilles Tendon Repair +/- Calcaneal Exostetomy
  • Tarsal Tunnel
  • Nerve Procedures of the Ankle

-You will be in a posterior splint following surgery. Follow up to the office 5-7 days after surgery. Keep the postoperative dressing dry. Elevate and ice the leg for comfort. Your dressing will be changed and you will then be transitioned into a walking boot.

-You will be in the walking boot but will remain non-weightbearing for 3-4 weeks. You will be given a compression stocking to help alleviate swelling. The boot is taken on and off to shower and sleep. Range of motion is encouraged when the boot is removed when you are non-weightbearing.

-You will then begin a gradual increase to full weight bearing in a walking boot as pain and swelling allows for another 4-6 weeks. The boot is taken on and off to shower and sleep. Range of motion is encouraged when the boot is removed when you are non-weightbearing. You will be given a compression stocking to help alleviate swelling.

-You will then be prescribed 4-6 weeks of physical therapy if necessary which will increase your strength, motion and flexibility.

Foot and Ankle Standard Protocol #4

  • Ankle Arthrodesis
  • Triple Arthrodesis
  • Pantalar Arthrodesis
  • Talar /Calcaneal Fractures
  • Tibiotalarcalcaneal Arthrodesis
  • Talonavicular Arthrodesis
  • Medial Double
  • Subtalar Joint Arthrodesis
  • Calcaneal Osteotomies +/- Tendon Repair
  • Midfoot Arthrodesis/Fracture

-You will be in a posterior splint following surgery. Follow up to the office 5-7 days after surgery. Keep the postoperative dressing dry. Elevate and ice the leg for comfort. Your dressing will be changed and you will be placed back in the posterior splint.

-After the sutures are removed at your 2 week appointment you will be placed in a fiberglass cast for 3 weeks and will be completely non-weightbearing. No weightbearing activities are allowed: no walking, standing, or balancing on the cast. Crutches, a walker, knee scooter or a wheelchair is needed.

-You will return to clinic to have your cast removed and placed back into a fiberglass cast for another 3 weeks and will be completely non-weight bearing. No weightbearing activities are allowed: no walking, standing, or balancing on the cast. Crutches, a walker, knee scooter or a wheelchair is needed.

-At your next visit the cast will be removed and you will be placed in a boot walker for 4-6 weeks. This begins a gradual increase to full weight bearing as pain and swelling allow. The boot is taken on and off to shower and sleep. Range of motion is encouraged when the boot is removed when you are non-weight bearing. You will be given a compression stocking to help alleviate swelling.

-You will then be prescribed 4-6 weeks of physical therapy which will increase your strength, motion and flexibility.

We would like to provide you with some information that you may find helpful while planning for and recovering from your surgery with Dr. Donovan.

Medications

Typically, Dr. Donovan prescribes 2-3 medications for your surgery. The prescriptions will be given to you at the hospital prior to your discharge or preoperatively in the office. The number and type of medications you receive will vary depending on your individual needs. These prescriptions should provide you with enough medication until your first visit in the office after surgery. If you require additional medication before this appointment please plan ahead as some pain medication cannot be called into your pharmacy and will either need to be mailed to your home or require an office visit. We can only handle medication request during regular office hours. Please keep in mind that the laws have now changed for prescription narcotics and we can no longer call in refills for Norco (hydrocodone). They have now moved to the Schedule III category like Percocet (oxycodone) and the prescriptions now have to be hand carried to the pharmacy.

Your medications may include:
A narcotic pain medication such as Percocet (oxycodone), Vicodin/Norco (hydrocodone). Please remember that these medications seriously and adversely affect your judgment and response times, so drive responsibly. You should not consume alcoholic beverage while taking narcotic pain medication. In addition to the pain component of these medications they also include Tylenol (acetaminophen). You should not take any additional product that contains Tylenol (acetaminophen). This prescription, like most narcotic pain medications, has a tendency to cause constipation. The best remedy for this, should it occur, is to increase fluid intake, increase activity as tolerated and increase dietary fiber by eating more fruits, vegetables and whole grain cereals, breads and bran.

A medication called Aspirin. This medication requires a prescription and can be picked up at your local pharmacy. Take it once daily until you are full weight bearing without a cast or splint. This medication and a compression sock on the non surgical leg are used to help prevent deep vein thrombosis commonly referred to as blood clots. If you are prescribed Lovenox, Xalerto, Heparin or Coumadin due to a history of blood clots or due to the length of your non weightbearing perior post operatively, we will have you stop the Aspirin.

An anti-nausea medication Phenergan (Promethazine) or Zofran(Ondansetron). This medication may be taken every 8-12 hours as needed to assist with nausea after surgery.

It is recommended that you spread out your medications and not take them in the same sitting. This will help us determine which medicine may need to be changed should you experience any intolerable side effects. Should any of these medications cause itching or hives, stop the medication and notify us so Dr. Donovan can prescribe an alternative medication. Increasing your fluid intake will help flush the medication out of your system and get you quicker relief. You may also find Benadryl helpful in calming your reaction. Benadryl can be found at your local pharmacy without a prescription.

Another possible adverse reaction when taking new medication may be nausea and/or vomiting. Should this occur, discontinue the medication. Dr. Donovan may prescribe an alternative medication and something to calm the nausea if necessary.

Symptoms

Your foot/ankle may be numb and painless for as long as 24 hours after surgery. This is due to the local anesthesia used during your surgery. When this wears off your will start to experience normal postoperative pain. It is important that you not wait for the pain to become unbearable before taking your medication. By doing so, it will greatly affect your ability to obtain timely pain relief. Use your pain medication generously in the first week after surgery. You may experience swelling or a feeling of tightness and throbbing when your foot is resting on the ground. Elevating your leg above the level of your chest and the use of a basic ice bag behind your knee can help relieve this.

Warning Signs for a Blood Clot

If you experience constant cramping in your calf not relived with elevation or your calf is hard, warm or red contact our office. If you experience shortness of breath or sharp chest pain go immediately to the nearest emergency room. In addition, you will be asked to wear a compression stocking on your non-operative leg until you begin the weight bearing process. This is to reduce the risk of a blood clot.

Bandages

Keep your dressing dry and intact until your first office appointment. If your dressing becomes wet you will need to be seen that day or the following morning to have it changed. You may notice some bloody spotting or drainage on your dressing and this is normal. The purpose of the dressing is to provide compression and absorb any drainage from the surgical incision. Call the office if the size of the spotting enlarges rapidly.

Equipment

There are some items that you will need while recovering from your surgery and others that will make some tasks more convenient, but not necessarily required.

  • Crutches, Walker, Turning Leg Caddy/Roll-A-Bout – Since you will not be able to put weight on your operative foot immediately after surgery you will require some type of device to assist with ambulation. This can be in the form of crutches, a walker or wheelchair. Which device is best for you depends on your individual needs and overall physical strength. Some patients like to obtain these prior to surgery to familiarize themselves with the product and take a little time to practice. You may also choose to use a Roll-A-Bout or Turning Leg Caddy to keep the weight off your operative foot.
  • Cast/Dressing protector – During your immediate postop period and when in a cast you cannot get this extremity wet. We have products available that will help protect your surgical dressing and cast while making showering more convenient.
  • Compression Stockings – Used in conjunction low dose with aspirin or other medications to help blood blot prevention. This is typically worn on the non-surgical leg.

Activity

You should not put any weight on the operative foot/ankle until Dr. Donovan has given approval. If surgery was on your right foot/ankle or if you drive a standard vehicle, you should not drive until cleared by Dr. Donovan.
You should call the office if you experience any of the following symptoms after your surgery:

  • High fever (greater than 101 degrees) and chills
  • Uncontrollable bleeding
  • Inability to urinated for more than 8 hours
  • Calf cramping
  • Sudden color changes to your toes or if your toes turn white
  • Foul odor coming from your dressing
  • Severe onset of pain not controlled by pain medication