Trauma and Orthopaedics
Why am I having this operation?
The foot is a very complex structure with many bones, joints, muscles, tendons and ligaments working together for support, balance and movement. If any of these structures fail you may suffer with pain, stiffness, swelling and deformity that affects how you manage your daily activities.
The aim of foot surgery is to restore your ability to walk and improve your symptoms.
You should be aware of all the factors we consider before offering you surgery. Surgery is the last resort.
Foot problems can be treated in many ways without having an operation. These include:
- Orthotic insoles and shoes
- Physiotherapy and exercise
- Rest from activity
- Medicines
Steroid injections
- An operation will only be offered when all of these treatments have been tried or considered first.
- Surgery usually offers a successful outcome, however occasionally there may not be a surgical option to relieve your symptoms.
- Sometimes you may not be offered surgery if the risk to your overall health is too high and there is the chance it could make your condition worse.
- If you are suffering a lot, surgery may still be offered, if there is no alternative, even though the chance of success is low. In this situation you must accept the increased risk of failure.
- Surgery is not offered to alter the appearance of your feet if you have no other symptoms.
Smoking
Smoking can seriously affect your risk of complications after surgery. These increased risks include:
- Wound breakdown
- DVT
- Wound infections
- Failure of the bone to unite or heal
Do you have any health problems?
Certain conditions cause problems with anaesthesia and surgery, so you must let us know all about your health. Try and remember all of the medical problems and operations you have had.
Medicines
Be prepared with a list of your medications. It is important to tell us about any allergies you have. Some medications need to be stopped before surgery or can cause problems with anaesthesia.
Post-op considerations within your home
Most foot surgery means you will be less mobile for at least 2 weeks. If you live alone you will need to think about who can help you with things like shopping and preparing meals.
- How wide are your hallway and doors?
- Have your stairs got a banister for support?
- Will you be able to get upstairs to bed or could you make a bed downstairs temporarily?
- Where is your toilet and could you get on and off the seat easily?
We can advise and arrange some modifications to help you at home if you let us know your concerns before your surgery.
Admission
- You may be asked to come into hospital the day before surgery if you have health conditions that require special attention.
- If you cannot get to hospital early in the morning, please inform us before the day of surgery to prevent any delays.
- The surgeon will go through your consent form and the risks of surgery, then you will be asked to sign it. You have the right to change your mind at any time.
- The length of stay after the surgery depends on your health and the nature of the operation you are having. Many operations are done as a day case or with an overnight stay.
- Some complex foot and ankle procedures can expect a stay in hospital of 1 to 3 days.
- The anaesthetist will come and talk to you about your health and previous experience of anaesthetics. If you have had any problems before, please let the anaesthetist know, and they will try and prevent the same problems occurring.
- The majority of foot surgery is performed under general anaesthetic, but it is usual for a local anaesthetic block to be used as well. Part or all of your foot and leg will be numb for up to 24 hours as a result. This helps enormously with pain relief after the operation, but it is important that you start taking pain tablets regularly before the block wears off.
Surgery
You will be taken to the theatre suite and checked in, then you are taken to the anaesthetic room for your anaesthetic before finally going into theatre.
Post-operatively you will spend some time in the recovery room before going back to the ward. If you have had a general anaesthetic, or something to make you sleepy during surgery, it may be several hours before you will be ready to talk to visitors.
After surgery
After the operation you will have dressings, padding and either a bandage or a ‘plaster cast’ on your foot.
There will be special instructions as to how to look after your foot after the operation, these may include advice on the following:
Foot checks
Check your operated foot regularly and make a note of its colour. It is normal to have bruising following surgery.
If you notice the following:
- Persistent blue colour
- Pins and needles getting worse
- Persistent numbness
Massively swollen foot and toes
Please contact a member of the foot and ankle team immediately, or visit your nearest accident and emergency. If you are unable to reach a member of the team, then you must either ring the ward, your GP or attend your nearest accident and emergency department urgently.
Elevation
This is very important to reduce swelling in your foot and ankle. For the first 2 weeks you must spend 50 minutes of every hour resting with your foot elevated above heart level. Swelling can make your pain worse and cause other serious complications such as slower wound healing, infection and stiffness.
Ice
Cold therapy may help with pain and swelling. You can use a bag of peas wrapped in a tea towel to protect your skin. This can be applied over your foot, bandages or cast.
Pain relief
Please read carefully the instructions given to you with your painkillers. Some painkillers have potentially dangerous side-effects and you must stop taking them if the warning signs appear. Usually painkillers are most effective when taken regularly as prescribed.
Dressings and wound care
You will be told when bandages can be removed. You must keep the wounds covered until we see you in the clinic two weeks after your surgery. If you have a ‘plaster cast’, you must keep this clean and dry at all times as a damp ‘plaster cast’ can cause skin and wound problems.
Weight bearing
If we ask you NOT to put weight onto your foot then it is very important to follow our advice. If you weight bear too soon you can loosen screws in the bone or damage any soft tissue repairs.
Weight-bearing and mobility depends on what type of procedure you have had:
- Full weight bearing
Walk as normal putting weight on your operated foot. - Partial weight bearing
You may put some weight on your foot and will be instructed how much is acceptable. - Heel weight bearing
Usually following toe surgery. You can put your weight on your heel and the outside of your foot. We supply a shoe to help with this. This can be removed when resting. - Non weight bearing
You must not put any weight on your operated foot. You will be shown how to use crutches by a physiotherapist.
Physiotherapy
Physiotherapy may be helpful after foot surgery. Your surgeon or practitioner will arrange for you to have physio if they think it will be beneficial. Your physiotherapist will advise you on safe ways to increase weight bearing and movement.
Driving
Do not drive until you can wear a normal shoe and can trust your foot completely. When you go back to driving, inform your insurance company about your operation.
Sport
The amount of time before returning to sporting activities will depend on your sport and the operation you have had. Check with your surgeon or practitioner before starting any sport.
The risks of surgery
All surgery carries some risks. If you decide to delay treatment this could cause the condition to become worse and more difficult to treat.
If complications occur in foot surgery it can be severe, even causing your symptoms to be worse than before your operation.
You must decide what level of risk you are prepared to accept, surgery may not be the right choice for you.
Your treatment only starts with an operation, there will be a list of instructions you will have to follow after your surgery.
Complications are more likely if you do not follow the post-operative instructions, so the success of your operation depends partly on you.
Surgery has many advantages, but things can go wrong. Generally, problems can be divided into two groups:
- Local complications at the site of operation (such as infection),
- General complications from the stress of the surgery and anaesthetic (such as a chest infection or stomach ulceration).
Serious long-term harm is rare. The risks will be discussed and documented when you consent for your operation.
Take this opportunity to read the list carefully.
Local complication
Bleeding, haematoma, bruising, damage to major blood vessels (requiring surgical repair, resulting in swelling or poor circulation), increased muscle pressure (needing further surgery to avoid muscle damage for example, decompression, skin grafting), interruption of blood supply to bone (causing disturbance of bone growth in children and, or collapse and deterioration of joints).
Infection, wound breakdown, skin irritation or breakdown, persistent tenderness or changes in skin sensation near scars, heaped up or broad scar.
Implant breakage, breakage of bone while inserting or removing implant, implant allergy. Implant dislocation, implant loosening and wear, leg length discrepancy, difficulty in implant removal or revision.
Failure of divided bone, fracture to heal, or loss of position, late fracture through site of operation, or screw holes. Failure of ligament, tendon, soft tissue repair or reconstruction.
Damage to major nerves, resulting in absent or abnormal sensation, or pain, local weakness or paralysis of the limb, regional pain syndrome (unpredictable occurrence of severe pain and stiffness).
Failure of surgery to achieve objectives, recurrence or persistence of problem, surgery satisfactory and uncomplicated but result fails to match patient expectations.
Secondary surgery or other treatment may be required to deal with some of these complications. Very rarely permanent disability or loss of part or all of the limb may result.
General complications
Heart attack or disturbance of heart rhythm, stroke or mini stroke, blood clot in leg veins and, or lung blood vessel blockage (DVT and, or PE), ulceration or bleeding in the stomach. Chest infection, or other breathing complication. Waterworks or bowel infection. Epileptic fit, confusion, nerve damage from regional and, or spinal anaesthetic. Infection from blood transfusion (for example, Hepatitis, HIV or AIDS). Allergic or other reaction to drugs or transfused blood. Temporary worsening of pre-existent diabetes. Bed sores.
Some of these complications can have fatal outcomes, although this is rare.
Finally
You must remember that your treatment only starts with an operation. Complications are less likely if you follow our advice. Please ask the doctor or practitioner if you are unsure or have any concerns.
Contact us
For advice or post-op queries, please contact the foot and ankle specialist practitioners on:
Telephone: 07970 199422
Email: [email protected]
Patient experience
South Tees Hospitals NHS Foundation Trust would like your feedback. If you wish to share your experience about your care and treatment or on behalf of a patient, please contact The Patient Experience Department who will advise you on how best to do this.
This service is based at The James Cook University Hospital but also covers the Friarage Hospital in Northallerton, our community hospitals and community health services.
To ensure we meet your communication needs please inform the Patient Experience Department of any special requirements, for example; braille or large print.
T: 01642 835964
E: [email protected]