Foot surgery is often unique from other types of surgery in that the weight and stress of the body is placed directly on the surgical site during recovery, unlike abdominal surgery or back surgery. Even knee and hip procedures are not as directly affected post-operatively by the weight of the body on the ground as the foot. For this reason, recovery after foot surgery is often difficult for some, especially if the surgeon’s instructions are not followed completely or are ignored. This article will discuss ways to help make recovery from foot surgery easier.
First and foremost, it must be mentioned that there are many different procedures that are performed on the foot and, by extension, ankle. Each of these procedures have different requirements for recovery, and some even have very unique instructions that must be followed for a successful recovery. The surgeon’s specific instructions are important and must be followed. The advice in this article is meant to be a general guide to recovery from a typical foot surgical procedure, but may not offer a complete picture of an individual’s specific recovery needs. The last word in one’s specific recovery comes from their surgeon, and not this article. This should be kept in mind as one reads the following information.
Surgery is essentially an intended injury to the body. It is neither natural or healthy for an incision to be made into the skin and deeper tissue cut, moved, or removed. The body treats even the most skillfully performed surgery as an injury, similar to a stabbing wound, sprain, or broken bone. The body has a natural recovery process it initiates immediately upon being injured. This process involves an alphabet soup of chemicals, cells, and reactions that immediately set upon the injured tissue in an attempt to begin the mending process. This initial process is known as inflammation, and consists of swelling, warmth, and perhaps redness. It externally may look similar to an infection, as the body’s response to bacteria is similar. This inflammation can create the majority of pain after foot surgery for several reasons. Firstly, the foot has a limited area that tissue can swell within, and any excessive swelling can push against nerves and other sensitive tissue causing pain. Secondly, since the foot is usually the lowest point of the body, gravity will naturally force fluid into the foot more than any other part of the body. The period of time this initial inflammation lasts is usually four to seven days after the surgery, with a gradually tapering after that time period. Moderate inflammation certainly will persist much longer following this time period, but the lion’s share of the swelling and the various chemical reactions involved in the inflammatory process peaks and declines within the first week following surgery. Because of the potential of this process to cause a great deal of throbbing or stabbing pain following surgery, all instructions on icing, elevation of the foot, and activity restriction, which will all decrease the inflammation, should be followed. Sometimes anti-inflammatory medications are also used during this period to help decrease the inflammation. It should be recognized, however, that this inflammation is vital and necessary to the healing process, and some inflammation is needed to begin mending the surgical site. The body does tend to overdo this reaction significantly, and there is a great amount of inflammation that can be reduced to limit pain while leaving enough for the healing process.
Some pain following foot surgery is not directly related to the healing process, but to the actual incision or act of cutting. The foot contains an enormous network of nerves, many of which are minuscule. Foot surgeons are careful to avoid cutting visible nerves during surgical dissection (unless it is a nerve that is being removed). However, microscopic skin nerves do get severed during the act of making an incision, and this cannot be avoided. Sometimes, despite the most careful work, minor nerves do get damaged or severed during the surgical process. In general, all these nerves do heal uneventfully, but can create pain in the immediate days following surgery that is often unaltered by icing, elevation, or anti-inflammatory medication. This type of pain is best controlled by narcotic medication, and that is the very reason why narcotics are often prescribed for use after surgery. For the most part, narcotic use in foot surgery is usually limited to the first two or three weeks following surgery at the most. Pain that persists longer that is unrelieved by icing, elevation, or anti-inflammatory medications is unusual, and further investigation needs to be done by the surgeon to determine the cause. Of course, every patient’s tolerance to pain is different, and there are those out there who are excessively sensitive to pain and discomfort. However, the vast majority of patients have little remaining pain three weeks following foot surgery, excepting for mild soreness or stiffness. There are a few procedures in which this may not be true, including surgery to release or sever nerve tissue, surgery that requires multiple procedures at the same time, complicated fracture repair, or major foot reconstruction. Because of the often traumatic nature of these procedures, the inflammation process or general nerve-related pain may last much longer.
One of the biggest mistakes people make after foot surgery, outside of not icing or elevating the foot, is to resume semi-normal activity shortly after the surgery. The unique point about foot surgery is that, unlike abdominal surgery for example, the body usually feels great shortly after the surgery. The desire and tendency to get up and become active is strong. Unfortunately, the foot is not in any position to resume normal activity, and the surgical site can actually be harmed by such activity. The tissues that are held together by stitches need time to mend, and immediate activity can stretch and pull on these fragile bindings. More inflammation, delayed healing, and future excessive scar tissue can result from early activity. The skin incision may even split open. By becoming active earlier than advised, the natural push of gravity will force fluid into the foot, increasing and prolonging the inflammation process, and possibly resulting in long term swelling that will persist months following surgery. If bone was operated on, and pins, wires, screws, or staples are holding the bone together, early activity against the advice of the surgeon can result in a fracturing of the bone, or at least a delayed or abnormally positioned healing. There are some procedures, particularly joint implant or remodeling procedures, that require early activity to prevent joint stiffness. By following the surgeon’s specific instructions on post-operative activity, long term complications and unnecessary pain can be avoided.
One final way of making foot surgery recovery easier has to do with keeping the dressing clean and intact. One of the most common complications seen across all types of surgery that can make recovery difficult is infection. Although the surgery is performed in a sterile environment, bacteria can still invade the surgical site following surgery. Many times this is due to patients getting their dressing wet or heavily soiled. Bacteria has the capability to travel through multiple layers of gauze, and can easily invade the surgical site when helped along by water, or when material is smeared into the dressing that has a high bacterial count. Many people have natural resistance to bacteria on the skin level, but when an incision is present this can be an automatic portal for bacteria to enter the less resistant deeper tissue. There are also those who are at greater risk for infection, including diabetics and those with compromised immune systems. Surgical infections can run the range from simple skin infections that only need oral antibiotic medication to serious infections involving deep tissue and bone that need intravenous antibiotics, hospitalization, and possibly more surgery. By keeping one’s dressing and bandages dry and clean, and by not removing the dressing before instructed to do so by the surgeon, one can have a reasonable sense of protection from infections. Of course, infections do sometimes occur out of the blue in even the healthiest of patients. However, these uncommon and spontaneous infections are hard to prevent or anticipate.
By ensuring that the foot is iced, elevated, rested, and kept dry and clean, the majority of issues that follow recovery from foot surgery can be reduced in severity or avoided altogether. Strict following of the surgeon’s instructions is very important, as only the surgeon is truly aware of the nature of the surgery and what the subsequent recovery period requires. By keeping this in mind, one can ensure a comfortable and speedy recovery from foot surgery.