Planning Before Surgery
Decreasing Risk of Infection:
Get a bottle of Hibiclenssurgical scrub (or other chlorhexidine wash) and use it as your shower gel for the week before surgery. Do not get it in your eyes, but pay close attention to your feet and scrub them well.
Come to surgery with hair washed at least the night before to decrease the amount of bacteria.
Remove nail polish from the toes and be sure the nails are clean and trimmed. Remember that your toes will be in the sterile field! Do not let a pedicurist trim the cuticles or attempt to remove an ingrown toenail.
Sleep in clean pajamas and freshly laundered linens before surgery.
Avoid any scrapes or cuts in the weeks leading up to surgery. If you arrive on the date of surgery with any skin injuries, the surgery may be delayed or canceled.
Improving Healing Potential:
Do not use any nicotine products leading up to surgery.
Eat a balanced diet; eat lightly to reduce constipation, and increase fluids and fiber in your diet.
Take a Vitamin D3supplement of 5000iu daily, along with adequate dietary calcium (equivalent to four servings of dairy)
Stop herbal supplements and discuss with your internist
If you’re having surgery for an injury, be sure to elevate well above the level of your heart as much as possible to decrease the swelling.
Home Safety Preparation:
Move obstacles such as throw rugs, extension cords, and clutter out of the walkway. There should be a clear and wide pathway between the bed, kitchen, and bathroom
Bathroom: You’ve been prescribed a shower hose, shower chair, and shower bar to assist in hygiene. A handyman can help to install the bar.
Stairs: If you are not permitted to bear weight on the foot, sometimes climbing the stairs seated is the safest and easiest way. Try to find ways to minimize the number of trips up and down stairs.
Driving:
Arrange to have someone drive you to your appointments after surgery. If you had surgery on your left foot and you have an automatic car, you can anticipate being able to drive after complete cessation of narcotics.
If it is the right foot, do not drive until you have regained the range of motion, strength, and reaction time needed to drive safely. This cannotbe done until cleared for weight-bearing in a regular shoe, but clearance of weight-bearing does not imply that you are safe to drive.
Prescriptions:
Be sure to pick up your prescriptions prior to surgery. Ensure that Ryann has your current pharmacy preferences.
Cooking:
Try to cook and freeze meals in advance, have friends or family assist, or order in. Standing in the kitchen for prolonged periods will not be possible after surgery.
Travel:
Flying is not recommended for at least four weeks after surgery. Long car trips are strongly cautioned against and are also not recommended. There is a risk of wound complication, compartment syndrome, and blood clot (DVT, PE) in traveling shortly after surgery.
Any potential travel plans must be disclosed to Dr. Dixon and planned for, which sometimes necessitates rescheduling the surgery.
The Day of Surgery
- Take only the medications you have been told to take by your internist with a small sip of water
- Comply with strict instructions about food/beverage consumption. Ice chips, gum, and mints are not allowed on the day of surgery
- You may have nothing to eat or drink after midnight on the date of surgery, including water
- Do not wear makeup, jewelry, lotions, or perfume
- Do not take insulin unless otherwise instructed
- Do not take oral diabetes medication (pills) on the morning of surgery
- Shower with hibiclens, scrub the feet, and wash your hair.
- Please ensure that fingernails and toenails are free of any nail polish or dirt
- Please remember to bring insurance card and photo ID with you to the hospital. Please leave any valuables and jewelry at home.
- If you have been instructed to bring a boot, shoe, crutches, walker, or knee scooter, please bring those as well
- You may not drive yourself home after surgery or take public transportation. Please arrange ahead of time. Our staff will give an estimated time of discharge.
- Should you have any questions, do not hesitate to contact this office and we will be happy to help you.
PLEASE ARRIVE TWO HOURS PRIOR TO SCHEDULED SURGICAL TIME. IF YOU ARE NOT
PRESENT ON TIME, YOUR SURGERY WILL BE DELAYED OR CANCELED.
After Surgery
Weight-Bearing Status:
- Non weight-bearing: This means that no weight should be put on the foot and that you can cause damage to the procedure done by putting weight on it. You should use a walker and a rolling knee scooter to mobilize, and do so once per hour to minimize the risk of blood clots
- Weight-bearing as tolerated: It is still recommended to elevate as much as possible and minimize weight-bearing in the early weeks for the purpose of wound-healing, but the surgery is stable and can tolerate weight.
Prevention of Blood Clots
You should pump your nonoperative calf after surgery by moving your ankle up and down, and by getting up once per hour to move around the house.
If you are immobilized after surgery, there is a risk of blood clots. You will be prescribed either:
Enteric-coated aspirin: the risk is gastric ulceration. If you have significant abdominal pain, discuss
this with Dr. Dixon to be changed to Lovenox
Or
Lovenox: this is an injection into the abdomen. This will be prescribed if there’s a higher risk of
blood clot (such as personal or family history of DVT or PE), or history of ulcers with aspirin
Pain Control After Surgery
Elevate
The most important thing you can do is elevate your foot. Keep the foot well above the level of your heart, or “toes above the nose.” Keep pressure off of your heel and instead rest the muscular portion of your calf on pillows, a ramp, or the back of a sofa.
Medication
You’ve been prescribed narcotic pain medication. This may be cut in half to reduce side effects. The common reactions from narcotics are nausea, confusion, and constipation. In addition, they are highly habit-forming. For these reasons, we try to minimize the amounts of narcotics used. The supply should be adequate to taper downwards until the first post-operative appointment. After that time, nonnarcotic pain medications will be recommended.
Taking over the counter NSAIDS (two Aleves twice daily, or three Motrins three times daily) can significantly decrease the pain as well. Do not take additional Tylenol, as there is already a maximum dose of Tylenol in the narcotic medication.
Immobilization
Do not remove splint or boot unless instructed to do so. Do not remove any surgical dressing. If the splint or dressing becomes wet, call the office immediately. If there is significant splint related discomfort, call the office immediately.
What to do When Pain Control is Inadequate
If a nerve block or local anesthetic was administered, the block typically wears off in the middle of the night on the date of surgery. It is normal to have an increase in pain; this should be controllable with the narcotic pain medication prescribed.
- Be sure you are elevating. Increases in activity or leaving the leg lower than recommended will increase swelling, and this type of pain will not be resolved with any pain medication.
- Take two over-the-counter Aleve twice a day in addition to the narcotic pain medication
- Place an ice pack, always covered in a tea towel, at the back of the knee for twenty minutes per hour. Always allow at least 40 minutes between ice sessions.
- Is the splint or dressing tight? This is a different problem than pain at the surgical site and the dressing should be loosened immediately. Call the office immediately for instructions. After hours, you will be connected directly to Dr. Dixon.
When to Contact Dr. Dixon
- Severely increasing pain at the operative site
- There is new or increased redness or warmth, or drainage at the operative site
- The swelling is increasing significantly despite elevation
- The calf becomes swollen, tender, warm, or reddened
- You have a temperature above 101o for more than 24 hours
For more information, please visit https://aedixonmd.com