How to Prepare for Foot and Ankle Surgery: A Checklist

An operation on the foot or ankle is usually scheduled ahead, and the weeks before it are your main chance to influence how it goes. Below is a checklist in the order things tend to happen. It is general guidance. The instructions from your surgeon and the anesthesia team for your operation always take priority. The companion guide to preparing for foot and ankle surgery goes deeper on each topic.

Before you commit to a date

You should be able to answer five questions in your own words:

1. What exactly will be done, and why is it recommended for my foot?
2. What are the other choices, including leaving things as they are?
3. What result is realistic, and what could go wrong?
4. What will recovery ask of me and of the people at home?
5. Who do I call if something worries me afterward?

If any of these is still fuzzy, ask before scheduling. A second opinion is a normal step for a large elective operation; see second opinions before foot or ankle surgery.

The health review

Expect a pre-operative visit at which the team goes through your history, your allergies and everything you take, and looks for conditions that could complicate anesthesia or wound healing: diabetes, heart, lung or kidney disease, poor circulation, or earlier blood clots. Depending on your age and health, you might be sent back to your regular doctor for clearance, or asked for blood work or an electrocardiogram.

Your surgeon and the anesthesia team decide which medicines you keep taking and which you pause. Never adjust a prescription by yourself. Keep a written list of medicines and supplements, including over-the-counter products, and bring it to each visit.

The risks you can change

These are the ones with the clearest evidence.

• Smoking. A systematic review of foot and ankle surgery found that smoking, smokeless tobacco included, raised the risk of complications: bones that failed to join, infected wounds and slow bone healing were all more frequent in smokers than in non-smokers.^[1] Ask us for help with quitting before an elective operation.
• Diabetes and blood sugar. One prospective series followed 1,465 foot and ankle operations by a single surgeon and counted wound infections in 9.5% of patients with diabetes against 2.4% of those without. Nerve damage, rather than diabetes as such, was the strongest predictor.^[2] In a second series of 2,060 operations, patients whose diabetes had caused complications had roughly seven times the infection risk of patients with neither diabetes nor neuropathy.^[3] A Veterans Affairs database of 21,854 people with diabetes found that every 1% rise in hemoglobin A1c raised the odds of a complication by 5%, with neuropathy and other diabetes-related illness weighing more heavily.^[4] Your surgeon may want better control before an elective procedure and may involve your diabetes doctor. Operations for infection or a broken bone can’t be delayed, so they go ahead with a plan built around your condition. See smoking, diabetes and foot surgery healing.
• General health. Eating well, keeping blood pressure and other conditions in check, and getting skin problems on the foot treated all support healing.

If you develop a cut, rash, infection or a cold shortly before the operation, tell the office. Postponing can be the safer choice.

Pain control and anesthesia

The anesthesia team will recommend an option for you: often a nerve block (sometimes placed with ultrasound) combined with sedation, or a spinal or general anesthetic. Current pain plans pair blocks with non-opioid medicines and sometimes an added drug such as dexamethasone, so pain is controlled with fewer opioids.^[5] A meta-analysis of five randomized trials found that a continuous block behind the knee gave lower pain scores at 24 and 48 hours than one injection, at the price of minor problems with the pump, such as leaks.^[6]

The practical point: take your first dose of pain medicine before the block fades. Numbness can vanish quickly and the pain arrives with it, so follow the timetable you were handed.

Ask about blood clots

Clots in the veins of the leg are a known hazard of lower-limb surgery, particularly when the leg is held still. After foot and ankle operations they are uncommon overall. They are likelier after Achilles surgery and injuries, and in people who have had clots before, weigh more, are older or have certain illnesses.^[7] A review of 20,043 operations below the knee found symptomatic clots in 2.5% of patients.^[8] Nobody agrees on exactly who should receive preventive treatment, so it is decided case by case; ask what the plan is for you.^[9]

Set up the house

• Getting around. Agree on crutches, a walker, a knee scooter or a wheelchair with your surgeon, and try the device before the operation.
• Resting place. Create a spot where the foot can stay raised, with water, phone, medicines and snacks in reach.
• Bathroom and bedroom. Decide how you will shower and where you will sleep. A shower chair and a waterproof cover for the dressing can make a big difference.
• People. Line up help for the first few days and a ride home, since you can’t drive yourself.
• Work and family. Arrange time off, tell your employer what your job involves, and plan for anyone who depends on you.
• Shoes. Have a roomy shoe for the other foot ready, and expect to wait before the operated foot fits one.

The bunion surgery recovery timeline and driving after foot or ankle surgery help you plan how long these arrangements will last.

The last day or two, and the morning itself

• Fasting. The office will give you an arrival time and tell you when to stop eating and drinking. Stick to it exactly, because a snack or a drink at the wrong time can cancel the operation.
• Pack: photo identification, your insurance card, your medicine list, and a contact for the adult who is taking you home.
• Wear something loose and comfortable, and leave valuables and jewelry behind.
• Where: the operation takes place at a hospital or surgery center where Dr. Ozturk has privileges, and most patients leave the same day.

Questions for your pre-operative visit

• Which of my medicines should I continue, and which should I pause?
• What type of anesthesia and pain plan do you suggest?
• Am I more likely than most to get an infection or a clot, and what will we do about it?
• When may I put weight on the foot, and what will I use to move around?
• Whom do I call about a problem, day or night?

Common questions

Should I stop smoking before surgery?

Yes, if you can, and ask us for help. Smokers had more infected wounds, more bones that failed to join and slower bone healing in the review.^[1]

Will I need medical clearance?

That depends on your age and health. Some people are asked to see their own doctor or to have blood work or an electrocardiogram. Whatever tests are ordered, don’t change a medicine unless the team tells you to.

Will I be given a blood thinner?

There is no agreed rule for foot and ankle surgery, so your surgeon weighs your personal risk.^[9,7]

If I have a nerve block, will I feel anything?

The foot and leg go numb for many hours, but pain can return abruptly when the block ends, so take your medicine on schedule. In one meta-analysis a continuous block lowered pain scores at 24 and 48 hours.^[6]

What if I catch a cold or cut my foot before the date?

Call the office. A break in the skin, an infection or an illness close to surgery can be a reason to delay.

The bottom line

The basics carry most of the weight: understand the plan, have your health reviewed, stop smoking, tighten diabetes control if it applies, arrange pain control and get the house ready. Ask questions early and follow the fasting and medicine instructions exactly.