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Foot and Ankle Surgery Resources
If you are reading this section of my website, you are either curious about foot and ankle surgery, thinking about having foot and ankle surgery, or have already been scheduled for foot and ankle surgery. You have, no doubt, a number of questions about what lies ahead. Rightly so, since embarking on a plan of corrective foot or ankle surgery is a big decision. The uncertainty of what lies ahead often creates anxiety in most patients.
Prior to discussing the possibility of a surgical correction with you, I thoroughly evaluate your foot and ankle, as well as any necessary tests or images. When we discuss the surgery in my office, I try to give you a good idea of what the surgery can and cannot do for you. I want you to be fully aware of the procedure, the goals of surgery, the recovery process, and the risks of surgery.
However, even after we discuss the surgery in my office, you may still have unanswered questions or anxieties. Therefore, I have prepared this rather detailed guide about foot and ankle surgery with the objective of helping you to prepare more knowledgeably and confidently for your surgery. I hope that the following information will answer any and all questions that you may have.
About your doctor:
I am a foot and ankle surgery specialist with over 20 years of experience. I have been practicing at the Kaiser Medical Center in Santa Rosa since 1993. Before coming to the Santa Rosa facility, I was a faculty member in the Department of Podiatric Surgery at the California College of Podiatric Medicine and worked in private practice for nearly 10 years. I have been Board Certified in Foot and Ankle Surgery by the American Board of Podiatric Medicine since 1987.
Learn more about my professional background.
Learn more about me personally.
Contact me.
Scheduling your surgery:
Once you have agreed to proceed with surgery, I will digitally send your scheduling information to our surgery scheduler. If you have a rough date preference for your surgery, please mention it to me, so that I can include that in the scheduling request. Keep in mind that due to the nature of the foot and ankle surgery healing process, you should avoid scheduling surgery within 3 months of planning to travel. Once the surgery scheduler receives your scheduling request, he or she will contact you to arrange the surgery date. Unfortunately, the time of day that surgery is to be performed cannot be set until the day before the surgery – please notify me if you have a special request for time of day. The scheduler will also schedule your preoperative and postoperative appopintments, and mail you a preoperative planning packet including General Preoperative Instructions.
Preoperative visits:
Generally you will have a preoperative visit scheduled with me in the days just before the surgery. The purpose of the visit is to a) review your health and clear you for surgery, b) obtain written and verbal consent for the surgery, c) give written and verbal instructions for the post-operative period, d) make sure that you are provided with the necessary medication prescriptions and equipment that you will need after surgery, and e) complete any paperwork necessary for work, disability, or DMV placards. Additionally, depending on your general health and age, you may also be scheduled preoperative visits with your primary care doctor (for medical clearance for surgery) and with the anesthesiologist (for clearance for surgery and review of anesthesia/instructions). These additional visits, if scheduled, are for your absolute safety.
Medical history:
It is absolutely necessary that the entire team of providers that will be seeing you before and during surgery know your medical history. While we have access to your information in our computer database and in your chart, please understand that we want to confirm your most up to date medical status. Therefore, I ask that you complete a Surgical Admissions History Questionnaire that includes information such as your illnesses and past illnesses, any medications or dietary supplements that you take and the doses, any allergies that you may have, any prior surgeries that you have had, whether you smoke and how much, whether you drink and how much, and whether you use any illegal drugs – bring it to all of your preoperative visits. You will no doubt be asked numerous times about things such as your medications and your allergies by the many providers that compose the surgical team that will care for you – please bear with us, as we are trying to insure your absolute safety.
I prefer that you complete and submit the Surgical Admissions History Questionnaire online 48 hours or more before your preoperative appointment with me. Your form will be securely uploaded into your electronic medical record, so that I can review it before your visit with me. If you are unable to complete the form online, please print a hardcopy form, complete it prior to your preoperative visit with me, and bring it with you to your appointment with me.
Medications and supplements:
Please let your anesthesiologist and I know about all prescription or non-prescription medications or supplements that you are taking. Some medications and supplements may have the potential to cause problems due to, a) adversely interacting with anesthesia or perioperative medications that may be administered, b) causing excess bleeding at the time of surgery, c) impairing wound healing, or d) impairing bone healing. In most cases, problems can be prevented with appropriate awareness and planning in advance of the surgery.
Medications or supplements that may cause excess surgical bleeding -
If you are taking any of the following medications or supplements, please let me know at least two weeks before the planned surgery, so that modifications can be made to avoid excess bleeding, if possible.
- Supplements: Ginko biloba, Vitamin E, garlic
- Blood thinners: Coumadin (wararfin), Lovanox (enoxaparin), Pletal (Cilostazol), Trental (pentoxifylline), Plavix (clopidogrel bisulfate), Aggrenox (aspirin-dipyridamole)
- Anti-inflammatories and Aspirin: Asprin, ibuprofen, naproxen, indomethacin, sulindac, nabumetone, piroxicam, and many others
Medications that may slow bone healing -
If you are taking any of the following medications or supplements, please let me know at least two weeks before the planned surgery, so that modifications can be made to avoid impaired bone healing, if possible.
- Prednisone or other corticosteriods
- Anti-inflammatories and Aspirin: Asprin, ibuprofen, naproxen, indomethacin, sulindac, nabumetone, piroxicam, and many others
Medications that may slow wound healing -
If you are taking any of the following medications or supplements, please let me know at least two weeks before the planned surgery, so that modifications can be made to avoid impaired wound healing, if possible.
- Prednisone or other corticosteriods
- Methotrexate
- Enbrel (etanercept)
- Plaquenil (hydroxychloroquine)
- Chemotherapy agents
Smoking:
If you smoke, it is imperative that you stop before surgery and continue to not smoke after surgery. First, smoking can increase the risk of heart and lung complications during and after surgery. Second, smoking can impair both bone healing and skin healing – seriously placing the outcome of your surgery at risk. If you smoke, please click here to learn more about quitting.
Alcohol:
Alcohol does not mix well with pain medication that you might be taking following surgery. Alcohol can lead to inadvertent falls and disruption of your surgical correction. Alcohol can interfere with your body getting the appropriate nutrients that it needs to heal properly. Furthermore, alcohol can impair bone healing. Please limit your alcohol intake or eliminate it completely in the weeks before and after your surgery. If you need help quitting, please talk to primary care doctor or me about programs that we have to help you, or visit the Health Education Department.
Diet and supplements:
Prior to and after surgery, you should be attentive to the food, drink, and supplements that you consume. Eating a diet that provides adequate calories and protein will support the body’s healing process. Do not attempt to restrict your caloric intake (diet) in the two weeks before surgery and the two months following surgery. Discontinue any weight loss or diet pills at least two weeks before surgery.
Furthermore, you might be able to “boost” your healing. Insuring that you consume adequate amounts of good quality protein. Take a daily multivitamin. Add 500mg of Vitamin C two times per day. Take 220mg of zinc sulfate daily for the week before and the week after surgery. Consider going to the health food store and buying arginine to take for a week before surgery and two weeks after surgery.
Preoperative tests:
Depending on your age and health, the anesthesiologist may order an EKG and simple blood tests prior to surgery. If you are young and healthy, no tests may be required at all. In other cases, additional tests may be ordered, depending on the medical illnesses that you may have and the type of anesthesia that may be used in your case. I will generally have already have reviewed the tests (radiographs, MRI, CT, bone scan, etc) pertinent to the performance of your foot or ankle surgery with you prior to scheduling the surgery, so there are rarely any additional tests that I order immediately prior to surgery.
Postoperative instruction form:
I will prepare a Postoperative Instructions for Foot and Ankle Surgery form for you, containing pertinent instructions, your follow-up appointment date and time, warning signs, and phone numbers to call if there are problems after surgery. These instructions and the form will be reviewed with you and given to you typically at the time of your preoperative appointment.
Weight bearing status:
Following some foot and ankle surgeries, patients may be allowed to bear weight on the operated limb in a protected fashion. In other cases, absolutely no weight bearing on the operated limb will be required for up to 2 months after the surgery. I will discuss the weight bearing requirements of your procedure with you before surgery.
Equipment:
While some foot and ankle surgeries require minimal equipment/supplies afterwards, others can be quite involved. I will discuss your anticipated needs with you before surgery. Some items, such as a cane, crutches, and/or removable walking cast can be provided to you directly from our clinic cast room at the time of your preoperative visit, if needed. Other items, such as a post-operative shoe or cast shoe, will be provided to you in the recovery room on the day of your surgery, if required for your surgery. If I determine that you might need items such as a walker, wheelchair, or bedside commode, I will order it for you through our Durable Medical Equipment department and they will contract with Apria Healthcare to deliver it to your home. We cannot provide motorized wheelchairs or scooters. Another item that some of our patients have found useful for getting around while remaining non-weight bearing on the operated limb is the Rollabout Walker– we cannot order it, but you can rent them by contacting the vendor directly, if desired. In all cases, if the equipment is provided to you before the surgery, please practice with the equipment.
Postoperative shoes and casts:
After surgery, you should not attempt to wear your regular footwear on the operated foot/ankle until I clear you to do so. For some procedures, you might be provided with a postoperative Velcro-strap shoe to be used whenever you bear weight. This type of shoe will be given to you in the recovery room area after your surgery. You can remove it when you sleep. For other procedures, you might be provided with a prefabricated removable Velcro-strap walking cast. This type of cast will be given to you at the time of your preoperative visit. Bring it with you on the day of your surgery. Generally, you will be allowed to remove this type of cast for sleep, but confirm with me that it is ok to do so. Lastly, some types of procedures will require that you have a cast or splint applied at the time of surgery. A splint differs from a cast in that it does not completely circle the foot and leg, in order to allow for some swelling. For further information postoperative shoes, removable walking casts (Seton boot), casts, and splints, refer to Tips and Information from the Cast Room.
Care of bandages, splints, and casts:
You should never remove bandages, splints, or casts unless specifically instructed to do so by my or by my staff working under my orders. These will be changed at the time of your postoperative appointments. Bandages, splints, and casts must be kept dry. If they were to become wet, the risk of infection increases dramatically. If your bandage, splint, or cast becomes wet, call the Foot and Ankle Surgery Department or the Emergency Room (if after hours or on a weekend). You can also use a hair dryer on low or no heat to help dry out the bandage, splint, or cast – but please inform me.
Bathing after surgery:
Bandages, splints, and casts must remain dry at all times. Therefore, you must take special precautions to keep them dry while you bathe or shower. There are a number of options for keeping your bandage, splint, or cast dry:
- Use an over-the-counter short leg shower protector. You can purchase a Xerosox shower protector from The Depot Store next to the Department of Foot and Ankle Surgery.
- Use the double garage bag method – garbage bag above the knee, duct tape, garbage bag to a higher level, duct tape again
- Sponge bathe.
If you are also required to be non-weight bearing on the operated limb, bathing and showering presents additional hardships for you. Besides using one of the above options, you must take care to avoid weight bearing on the operated limb while getting in and out of the bath or shower, and while showering (if a shower is used). Some patients have benefited in this circumstance from using a small plastic garden chair as a shower chair, in order to sit while showering.
Preparing your home:
It is best to prepare your home before you actually have surgery, so that it is compatible with your recovery needs. Here are some recommendations:
Kitchen
- Prepare some meals ahead of time for yourself.
- Stock up the refrigerator, freezer, and pantry so that you will not have to go grocery shopping for at least two weeks.
- Stock the freezer with ice packs. An alternative to ice packs that works very well is a large bag of frozen corn or frozen peas – they can be refrozen and reused for the duration of your recovery.
- Place frequently used kitchen equipment and utensils in an easy to reach location.
- Remove throw rugs so that you will not slip or trip.
- Arrange for help preparing meals or explore Meals on Wheels.
Bedroom
- If you live in a two-story home, it would be helpful to prepare a sleeping area for yourself on the ground floor.
- Ensure sufficient lighting between your bed and the bathroom.
- Keep a flashlight at your bedside.
- Place the phone within easy reach at your bedside.
- You can cut out one side of a box and put it under your bed linens and blankets if you wish to avoid their pressure on your foot.
Bathroom
- Remove throw rugs.
- Consider a shower chair or plastic garden chair in your shower.
- Purchase a short leg shower protector (a device that keeps you leg dry while you shower) ahead of time.
Living Space
- Remove throw rugs or other objects (cords) on the floor the can cause you to trip or slip.
- Set-up your couch or a chair so that you will be able to make yourself comfortable and elevate your foot – make sure that you have foot rests to elevate your foot.
- Rearrange furniture to allow for clearance of crutches or walker (and wheelchair, if needed).
- Place a list of emergency phone numbers and our department phone number next to each phone.
- Bring your medications wherever you go.
- Plan sedentary projects for while you are recovering – reading, organizing photo albums, etc.
- Keep the TV remote control handy.
Wardrobe
- Allow ease in dressing by wearing loose-fitting pants, shorts, or skirts.
Driving and parking:
You will not be allowed to drive yourself home after surgery. If you do not have someone designated to drive you home after your surgery, the surgery will likely be cancelled. In the days and weeks following surgery, I may or may not allow you to drive. Before the surgery, I will discuss with you when it will be OK to drive. Do not drive after taking pain pills. Do not drive a manual transmission automobile when you have a cast on your left foot/leg. Do not drive at all when you have a cast on your right foot/leg. Since your operated foot/ankle will be lower than your heart, avoid driving or traveling by car any longer than 10-20 minutes in the first few weeks, as this will cause your operated foot/ankle to become more swollen and painful. When travel by automobile is necessary, always bring your required assistive device (cane/crutches/walker/wheelchair) with you. Attempt to park as close to your destination as possible. Before your surgery, we will discuss the possibility of obtaining a temporary disabled parking placard for your car from the Department of Motor Vehicles.
Work release/ disability/business office:
If you need a work release, I will complete a standard Kaiser work release letter at the time of our preoperative visit together (or sooner, if you require). You will be provided a copy for your employer. Furthermore, if you intend to file for disability income, you will need to submit a copy of the work release letter to our business office. The business office will take a copy of your signed work release and on your behalf, submit the necessary paperwork for disability income. All insurance forms and requests for leave should be submitted directly to the business office rather than to me. Kaiser Santa Rosa’s business office is located on the first floor of the hospital building, across from the main elevators.
Outpatient versus inpatient:
The majority of foot and ankle surgeries are performed on an outpaient basis, meaning that you will go home the same day (once you have recovered adequately from anesthesia). In some cases (particularly more involved reconstruction or injury cases), patients will stay in the hospital after their surgery is performed. In the hospital, we can provide intravenous pain management, and observe both your general health and your operated foot/ankle closer than if you went home. I will discuss with you well ahead of time whether your surgery will require a stay in the hospital. The document Patient Information for the Hosptial has additional information about staying in the hospital that should be helpful to you, should your surgery require a hospital stay. Most patients that stay in the hospital are discharged to home once their pain is in good control with oral medications, they are stable medically, and they are stable with their required gait status (usually non-weight bearing on the operated foot/ankle). In some cases, the patient is transferred from the hospital to a rehab facility in order to obtain further physical therapy assistance to achieve the desired gait status.
Type of anesthesia:
Most surgery involving the midfoot or forefoot (from the arch to the toes) is performed under local anesthesia with intravenous sedation. This means that your foot is anesthetized from the ankle down and you are sedated (sleepy). The amount of sedation can be adjusted by the anesthesiologist between very light to very sleepy, depending on your comfort level. This form of anesthesia is quite safe and usually does not require a long recovery in the recovery area.
Surgery involving the midfoot, rearfoot, ankle, and leg (from the arch to the leg) is usually performed under general or spinal anesthesia in order to assure that you will not feel any portion of the surgery and that you remain comfortable for the duration of the surgery. General anesthesia involves the use of anesthesia gasses, while spinal anesthesia numbs you from the waist down with an injection in your low back.
Additionally, the anesthesia type is determined by more than just the part of the foot, ankle, or leg that will be operated. The anesthesiologist and I will also strongly take into consideration your general health when selecting what anesthesia type will be most effect and most safe for you.
You will have the opportunity to discuss the type of anesthesia that will be used in your case with both an anesthesiologist and me prior to your surgery. More About Anesthesia
Risks of surgery:
You should be aware that while foot and ankle surgeries are usually successful, they are not entirely without risks. The risks of foot and ankle surgery may be related to the surgery itself or other perioperative risks.
Perioperative risks:
- Anesthesia complications
- Medication reactions
- Deep vein thrombosis
- Pulmonary embolism
- Cardiac arrest
- Death
Risks related to the foot and ankle:
- Nerve injury
- Numbness
- Weakness
- Loss of muscle control
- Tendon injury or disruption of tendon function
- Complex regional pain syndrome (CRPS or RSD)
- Circulation disturbance of soft tissues or bone
- Gangrene
- Loss of toes, foot, or limb
- Infection
- Wound or scar problems (poor or slow healing, thick scar, sensitive scar, unsightly scar)
- Failure of bone healing (delayed or non-healing of bone)
- Intolerance of hardware or implanted materials
- Failure or breakage of hardware or implanted materials
- Stiffness
- Arthritis
- Limp
- Chronic pain
- Chronic swelling
- Prolonged recovery
- Transfer of pain, fracture, or callus to new site
- Change in shoe size or inability to wear desired footwear
- Overcorrection
- Undercorrection
- Recurrent pain, callus, or deformity
Prevention of infection:
The risk of infection following foot or ankle surgery is typically very low – less than 1%. Contributing to that low risk is our attention to infection prevention. The surgical team and I focus our efforts on many ways to reduce infection risk, some of which are listed below:
- Antibiotics. I may order an antibiotic administered to you intravenously before surgery. Antibiotics after surgery are rarely used.
- Medication awareness/modification. Some medications, such as prednisone, can impair wound healing and increase the risk of infection. I will review your medications with you and may suggest modifications to reduce the risk of infection.
- Medical illnesses. Some illnesses, such as Diabetes Mellitus, can be associated with an increased risk of infection. I will review your medical illnesses with you and may suggest modifications to reduce the risk of infection.
- Bandage/cast care. A bandage or cast that becomes wet (from bathing, etc) following surgery can increase the risk of infection. Please call me as soon as possible, should your bandage get wet, so that we can change it. Do not remove the bandage yourself, unless specifically instructed to do so.
- Rest and elevation. Too much activity and having your foot below your heart too much in the first weeks following surgery can impair the lymph system and increase the risk of infection. Please keep your operated leg elevated close to or above heart level at all times in the first weeks following surgery. Avoid letting the foot down below heart level for more than 10-20 minutes at any time during this period.
- Diet. A diet that is too calorie and protein restricted can result in immune impairment and an increased risk of infection. Please maintain a diet that has adequate calories and protein.
- Infection at other sites. Infections at other sites of the body have the potential to spread by blood stream to the surgical site. In some cases, it is best to postpone surgery. If you develop a cold, flu, or any other type of infection in the two weeks prior to surgery, please report it to me. Examples include: urinary tract infections, prostate infections, skin infections, boils, respiratory infections with cough, fever, or colored sputum, and dental abscesses or gum infections.
Pain management:
Every person is different in how they experience and tolerate pain. Therefore, the degree of pain that patients experience following foot and ankle surgery can range from little or no pain to pain that requires regular use of pain relievers.
There are a number of methods that can help you alleviate pain, including the use of oral anti-inflammatory medications, narcotic pain medications, acetaminophen (Tylenol), elevation, ice packs, and relaxation techniques. Rest and elevation are a must following foot and ankle surgery, not only to keep pain to a minimum, but also to help the healing process and keeping swelling to a minimum.
I will usually prescribe your pain medication(s) at the time of your preoperative visit. It is probably better to pick them up at that time, rather than waiting until the day of your surgery.
If you need a refill for your pain management prescriptions, please do not call the Foot and Ankle Surgery Department. Instead, please call the EastFill number at (707) 571-4200 or request your refill online.
Narcotic pain medications can be given orally or by injection. Injectable narcotic medications are only utilized if you are in the hospital. Oral narcotic medications usually are composed of acetaminophen mixed with a narcotic. Because the oral narcotic medications have acetaminophen in their composition, and acetaminophen can be harmful to your liver if taken in excess, you should generally limit yourself to no more than 8 narcotic pain pills per day. For the same reason, you should not combine taking narcotic pain medications and over-the-counter Tylenol (acetaminophen) together. Narcotic pain medications also have the potential to cause constipation, so you should make sure that you are taking in plenty of fluids, and that you are consuming extra fiber in your diet. Furthermore, the narcotic pain medications can cause drowsiness, so you should not drive, operate potentially dangerous machinery, or engage in important decision-making while taking these medications.
The pain following foot and ankle surgery usually peaks in the first three days following surgery and tends to get better thereafter. However, if you were to neglect elevating your foot, the foot will become more painful and swollen. It is important to keep your foot elevated close to heart level, avoiding letting it down for any period in excess of 10-20 minutes for the first two weeks following surgery. I will advise you further about rest and elevation requirements at your first postoperative appointment.
When trying to gauge the level of pain that you are having, medical personnel will ask you to rate your pain on a 0-10 scale. Use the following scale as your guide in communicating your pain level to doctors and nurses:
0 painfree
1-2 mild
3-4 bearable
5-6 distressing
7-8 severe
9-10 intolerable
Implanted Hardware:
Metallic hardware is often used in surgeries involving bone cuts (osteotomy), bone fusion (arthrodesis), or fracture repair. The hardware is typically used to hold bones together in proper alignment while they heal. Examples of metallic hardware that might be used include bone screws, bone plates, staples, and pins. The hardware is typically made of surgical stainless steel, but can occasionally be made of titanium. It is most common to leave the hardware implanted over time. Hardware is removed in a few instances, if required for full restoration of function, or if the hardware is irritating.
I am often asked about the need for antibiotics before dental procedures if there is retained hardware in the foot. My answer is generally ‘no’, but I will advise antibiotics before dental procedures if the hardware has been implanted for less than one year. Another question that is common regarding hardware pertains to airport security machines. While an implanted screw or two might not trigger a screening machine, it is possible (depending on the machine’s sensitivity). I will provide you with a letter verifying retained metallic hardware, should you be planning on traveling through airports.
Advance Directives/Durable Power of Attorney:
Whenever we perform a procedure in the hospital, we are required to verify your desires in the event that you have a catastrophic need for life-sustaining intervention. You should mention your wishes to me in this regard. If you have Advance Directives and/or Durable Power of Attorney documents that you have previously prepared, please bring them to the admitting office when you check in to the hospital for surgery. If you would like to create these documents, click here for the forms and a tutorial. In addition, we offer classes if you need help completing these materials.
Blood transfusion:
Foot and ankle surgery does not usually require blood transfusions. Typically a tourniquet is used during surgery, so blood loss is minimal.
One week before surgery:
- Complete the preparation of your home.
- Stop smoking
- Stop taking aspirin and anti-inflammatory medications
- Start adjusting your diet and supplements in preparation for surgery
- Arrange for your transportation to and from the hospital on your surgery date.
- You will complete your preoperative appointments during this next week.
The day before your surgery:
- You will need to call 571-4670 between 1 and 3 pm to receive the scheduled time of your surgery and when you have to report to the Admitting Office.
- It is best to have already have picked up your medication prescriptions and equipment.
- Practice with your equipment.
- Remove any nail polish that you may have on your toes.
- If you will be staying overnight in the hospital after your surgery, pack your bag. Please review the document General Preoperative Instructions (pages 9 and 10) for what and what not to bring with you.
- Shower the night before surgery.
- Do not eat or drink anything after midnight before your surgery, unless directed to do so by the anesthesiologist. (see next section)
The day of surgery:
- Shower the morning of surgery.
- Do not eat or drink anything after midnight before your surgery, unless directed to do so by the anesthesiologist. Our anesthesiologists will usually allow the following: Clear liquids until 4 hours prior to the time you are told to arrive at the hospital. Absolutely no cream or milk. Clear liquids are limited to water, tea or sweetened tea (no cream or additives), black coffee (may contain sweetener but no milk, cream, creamer or flavoring), soda or diet soda (such as Coke or 7-up), apple juice. If your surgery is not scheduled until after 3PM, in addition to clear liquids, you may have toast (no other breads) with jam or jelly (no butter or other toppings) prior to 7AM. For further clarification, please check our Anesthesia Department's Fasting Guidelines.
- You will be directed by the anesthesiologist which medications to continue to take prior to your surgery today. Take only medications that you have been directed to take by the anesthesiologist. Take these medications with only a minimal sip of water. Our anethesiology department recommends that you do not take any of the following prior to your surgery today: Oral hypoglycemics - metformin (Glucophage), tolazamide (Tolinase), glipizide (Glucotrol), glyburide (Micronase), tolbutamide (Orinase), rosiglitazone (Avandia), pioglitazone (Actos) Diuretics - hydrochlorothiazide (HCTZ), Furosemide (Lasix), Triamterene/HCTZ (Maxide, Dyazide), Potassium Over the counter meds and health supplements - vitamins/minerals, herbs, decongestants, antacids (Tums, Maalox, Mylanta, etc.), laxatives/stool softeners NSAIDs - Ibuprofen (Motrin), Etodolac (Lodine), Sulindac (Clinoril), Naproxen (Naprosyn), Piroxicam (Feldene), Indomethacin (Indocin), Nabumetone (Relafen) Miscellaneous - Calcium Acetate (PhosLo), Sodium Polystyrene Sulfonate (Kayexalate), Sevelamer HCl (Renagel), Pancrelipase (Pancrease, Viokase)
- Do not swallow water when brushing your teeth.
- Do not suck on candy or chew gum.
- Arrive at the Admitting Department approximately 2 hours before your scheduled surgery. The Admitting Department for the Kaiser Santa Rosa Hospital is located on the first floor of the hospital building, just past the entry foyer.
- Please review the document General Preoperative Instructions (pages 9 and 10) for what and what not to bring with you.
Preoperative area:
- You will be checked in for surgery and your chart will be checked to make sure everything is in order.
- Your spouse or significant other will be allowed to be with you as you are prepared for surgery.
- You will be asked to change into a hospital gown and store your belongings in a locker.
- You will have your blood pressure, pulse, breathing, and temperature checked and your medical history reviewed once again.
- You will be asked to verify your surgery and mark the correct foot/ankle operative site.
- You will have an IV started in your hand or arm in order to give necessary fluids and medications.
- You will given intravenous medication to relax you.
- Your spouse or significant other will be directed to the waiting area when you are about to be transported into operating room.
In the operating room:
- You will have a team including an anesthesiologist/anesthetist, an RN, a surgical assistant, and myself attending to your comfort, your safety, and to the optimal outcome of your surgery.
- The entire team will conduct a “Time Out” before the surgery is started, during which the team confirms that your wrist ID bracelet, the surgical consent form, and your marking of the operative site all match appropriately.
In the recovery area:
- After your surgery is completed, you will be transported to the Post Anesthesia Care Unit (PACU). This is the recovery area.
- Your recovery will monitored and your care will be provided by highly specialized and experienced registered nurses in the PACU under the direction of the anesthesiologist and I.
- You must meet specific criteria before you can be transported from the recovery area. Therefore, the time in the PACU is typically an hour or more. However, the nature, extent, and length of your surgery, as well as the type of anesthesia utilized will determine the exact duration of time that you will spend recovering in the PACU.
- I will talk with about the surgery while you are in the PACU, but it is possible that because of the medications that you have been given, you may forget some or all of the conversation.
- I will also, with your permission, try to inform your spouse or significant other regarding the outcome of the surgery and your progress.
- Your spouse, significant other, or family will not be allowed in the PACU. The exception is for children having an operation – the PACU staff will bring in a parent of the child when it is safe to do so.
- Most patients having foot/ankle surgery are allowed to go directly home after their stay in the PACU (see outpatient vs. inpatient above). If you are required to stay in the hospital following your surgery, you will be transported from the PACU your hospital room (please also review the document Patient Information for the Hosptial).
After the surgery:
- You will need to have a designated driver bring you home.
- Follow the written and verbal Postoperative Instructions for Foot and Ankle Surgery that I gave you before surgery.
- Plan on doing nothing more than resting and elevating your limb for the first two weeks after your surgery.
- Keep your bandage dry and do not change it.
- Resume your normal medications, unless directed otherwise.
- Take your pain medications as directed.
- Do not smoke.
- You should first start with a clear liquid diet in the hours after you leave the hospital. If clear liquids are well tolerated, then progress to a diet that has adequate amounts of protein and resume recommended supplements.
- Call my office or the emergency room if you experience any of the “warning signs”.
Warning signs:
Call me at the Department of Foot and Ankle Surgery if you experience any of the warning signs below. The Department of Foot and Ankle Surgery phone number is (707) 566-5920 and is open 8:30am to 5pm Monday through Friday. At any other time, please call the Emergency Department at (707) 571 4800.
- Severe foot pain that is not relieved with elevation, ice, and medication.
- Bandage/cast accidentally getting wet.
- Fever over 100 degrees F, or lymph node tenderness in the groin.
- Severe calf pain, shortness of breath, or chest pain.
- Adverse reactions to prescribed medications.
Your first return visit:
On your first return visit, your cast or bandage will be removed for the first time. You should be aware that the foot and ankle will look nothing like it will when it is finally healed months down the line. In fact, for some patients, the site can be somewhat alarming, given that the bandages may have dried blood on them, your foot and ankle may be somewhat swollen and bruised, and you will see stitches at the incision site(s).
If you have a cast on your leg, the cast and stitches will be removed by an orthopedic technician on your first return visit. If you just have a bandage, but no cast, the bandage and stitches will be removed by my medical assistant. I will see you once these tasks are completed. When I see you, I will assess your progress and review the recovery plan that I will have you follow until our next visit together.
Usual recovery time:
The recovery time following foot and ankle surgery varies widely, depending on factors including how complex the surgery was, your age and general health, and your compliance with instructions (such as weight bearing status, rest, elevation). For most common foot surgeries, tenderness and swelling can take 3-4 months to resolve, while for more advanced surgeries, the recovery may take a full year.
Resuming footwear:
The problems of bone healing and swelling prevent early return to normal footwear following most foot and ankle surgeries. Sure, there are a few surgeries were a patient can be expected to resume standard footwear in as little as 2-3 weeks. However, a majority of foot and ankle surgeries take approximately 8 weeks before standard footwear can be attempted. If the surgery requires a cast, then there is typically a 2-4 week period of weaning back to shoes after the cast is removed (a removable walking cast is typically used during this weaning period). Therefore, if the surgery requires a cast for 3 months, then you can expect to be in standard shoes no sooner than 14-16 weeks. I will discuss my expectations for your return to standard footwear with you both preoperatively and postoperatively.
Return to work:
Since virtually all foot and ankle surgeries require rest and elevation of the operated foot for at least 2 weeks following surgery, it is rare that a patient will be allowed to return to work before 2 weeks following surgery. If you work in a sedentary occupation and can arrange your work environment so that you can continue to keep your foot elevated, it might be possible to return to work under these circumstances at approximately two weeks following some foot and ankle surgeries. If you work at a job that requires you to be on your feet for a substantial portion of the workday, it is rare that you would be allowed to return to work in less than 8 weeks following your surgery. In more complex surgeries, patients may be required to remain off work for as much as 3-6 months. I will discuss my expectations for your return to work with you both preoperatively and postoperatively.
Resuming activities:
Activities are usually progressed gradually in the following sequence: very restricted activities of daily living (ADL) with mandatory rest and elevation, restricted ADL with reduced rest/elevation, full ADL with restricted footwear, ADL with standard footwear, non-impact exercise activities with standard footwear, and finally, full exercise activities. The time it usually takes to progress through these levels is typically months, and is dependent upon how complex the surgery was, your age and general health, and your compliance with instructions (such as weight bearing status, rest, elevation). Therefore, it may take 2-6 months before full weight bearing exercise activities are started. Before full weight bearing activities are allowed, non-impact exercise activities may be allowed, including activities such as upper body weight lifting, swimming, stationary cycling, and elliptical trainer. I will discuss my expectations for your return to activities with you both preoperatively and postoperatively.
Rehabilitation:
Most foot and ankle surgeries require some type of rehabilitation. In most cases, I will give you instructions on the type, frequency, and duration of rehabilitation activities. These activities may include range of motion exercises, icing, contrast baths, and strength work that you perform on your own. In some cases, working formally with a physical therapist may be required, for which I make a referral. Rehabilitation activities may be started in some cases immediately after surgery, while in other cases, will be delayed until a cast is removed. In most cases, rehabilitation activities will last for 2-12 months.
In conclusion, I hope that the information provided here has enhanced your ability to knowledgeably and confidently prepare for foot and ankle surgery. Should you have any unanswered questions, please write them down, so that we can review them at the time of our next visit together. Or, you can e-mail me by using Kaiser’s secure e-mail messaging system.]
Commonly used documents and forms:
Surgical Admissions History Questionnaire - online form. I prefer that you complete and submit this online form 48 hours or more before your preoperative appointment with me. Your form will be securely uploaded into your electronic medical record, so that I can review it before your visit with me.
Surgical Admissions History Questionnaire - printable form. If you are unable to complete the online version of this form, please print this hardcopy version, complete it prior to your preoperative visit with me, and bring it with you to your appointment with me.
Preoperative Instructions for Foot and Ankle Surgery These are instructions to follow before foot/ankle ankle surgery.
Postoperative Instructions for Foot and Ankle Surgery These are instructions to follow after your foot/ankle surgery. I will go over these instructions during our preoperative visit and tailor them specifically for you.
General Preoperative Instructions This is an informative booklet prepared by our surgical services team. It will give you some important information and instructions regarding your preoperative appointments and preparing for your surgery.
Patient Information for the Hosptial This document contains helpful information and instructions regarding our hospital. It is particularly important if your surgery involves staying in the hosptial afterwards.
DMV Parking Placard Application. This is a link to the Califonia Department of Motor Vehicles website disabled parking placard application PDF document. For a temporary parking placard to use during the recovery period following your surgery, please print the document, complete your section, and bring it in to me on the day of your preoperative visit.
Advance Directives Forms If you wish to have valid advance directives in place before your surgery, please download and complete these materials. Submit them to the admitting clerk just before your surgery. If you need help completing these materials, click here.
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