Aiding recovery from foot and ankle surgery: part 2

Experienced consultant orthopaedic foot and ankle surgeon Mr Togay Koç follows up on his previous article about aiding recovery from foot and ankle surgery, discussing a return to normal activity levels.

How do patients begin walking or being active after foot and ankle surgery?

With some foot and ankle surgeries, you are able to walk immediately after the procedure, bearing in mind the elevation instruction that you must follow, as mentioned in part 1.

In these cases, you will be given a special shoe that goes on top of your dressings, while in other cases you’ll be asked to non-weight bear and may have to spend some time in a plaster or a boot.

Generally, following a period of time when you’re non-weight bearing, you will have to gradually return to full weight bearing within the plaster or boot.

Doctors advise that when you’re going from non-weight bearing to full weight bearing, you should do it through a graduated process. One way to do this is by weighing yourself with the plaster splint on, dividing the number by four and then using scales to weigh yourself in order to measure what the pressure feels like underneath the foot that has been operated on. Two weeks in, you must repeat the process again but must divide by two rather than four. You will familiarise yourself with how much pressure that feels like on the scales and progress to that amount of weight over the following two weeks.

50% of body weight means that you can stand on it evenly but as soon as your non-operated side leaves the floor, if you’re taking a step, that would be 100% weight-bearing and you will need your mobility aids for that process after those two weeks. If the 50% weight bearing has taken place, can put full weight bearing through it  if comfortable, still within your plaster or splint.

Generally, what doctors tend to recommend is that you try indoors without the boots and once you’re comfortable doing that, you can venture outdoors without the boots.

At this stage you shouldn’t rush into more than your foot and ankle can handle. Doctors recommend either starting with a short time or short distance to walk over and gradually increasing the amount of time or distance you’re walking outdoors, depending on your swelling and comfort levels. If you get too much swelling, you should reduce this. Ideally, you want to prevent swelling from occurring.

Once the initial healing period has passed, how can patients ensure they are supporting their foot or ankle well as they return to normal activity?

One of the most common things that doctors see from patients when they come out of their boot or shoe or splints is that they do certain amounts of activity but it increases their swelling, resulting in discomfort.

It is essential to have patience with the recovery. To encourage healing, you should try to avoid smoking and secondhand smoke, because it can interfere with bone and wound healing.

It is worthwhile to take a vitamin D supplementation and it may be useful to get your vitamin D levels checked before you have your operation. If the level is low, you may require a higher dose to bring you to normal levels, which will provide a strong bone healing environment and supplement that with a diet that is rich in calcium.

Evidence also suggests that taking vitamin C 500mg twice a day for 50 days following surgery can reduce the risk of developing comlex regional pain syndrome, where there is hypersensitivity around the region around and beyond the region of the operation. This can be quite debilitating, unpredictable and difficult to treat. Vitamin C has the potential to reduce the risk of developing this condition.

Before returning to driving, you must be able to do an emergency stop and operate the pedals without pain.  If you’ve had your left foot and ankle operated on and you drive an automatic car, you may be able to get back to driving sooner. Otherwise, you’ll need to be out of your cast, post-op shoe or boot in order to go back to driving safely.

Doctors advise taking off work for the first few weeks while the wounding is healing. If you have an office-based job, there may be a chance for you to reduce your activity level once the wound has healed. On the other hand, if you have a job which requires you to be on your feet or a physically demanding job, you’ll require more time off work, depending both on the surgery that you’ve had and taking into account any rehabilitation or physiotherapy plans that have been made around your surgery.

Overall, the recovery and return back to normal function can take as little as six months, if you’ve had lesser surgery, but may take between nine months to a year if you’ve had more major surgery.

If you are considering foot or ankle surgery and would like to book an appointment with Mr Koç, you can do so through his Top Doctors profile today.