Preparing for foot and ankle surgery

Before you decide

A good decision depends on good information. Before agreeing to surgery, you should understand what the operation involves, why it’s recommended for you, what results are realistic, what the alternatives are (including not having surgery), and what recovery involves. Our guides to bunion surgery, ankle ligament reconstruction and the other operations end with questions you can bring to your visit. Getting a second opinion is reasonable; see second opinions before foot or ankle surgery.

Your medical evaluation

Before surgery, we review your health history, your medicines and allergies, and any conditions that could affect anesthesia or healing, such as diabetes, heart or lung disease, kidney disease, circulation problems or a history of blood clots. Depending on your health and age, you may be asked to see your primary care physician for medical clearance or to have blood tests, an electrocardiogram or other tests before surgery. Your surgeon and the anesthesia team will tell you which of your medicines to continue and which to stop beforehand. Don’t stop or change a medicine on your own.

Things that improve healing

If you smoke, ask us for help to stop before an elective operation. A systematic review found that smoking, including smokeless tobacco, significantly increases the risk of complications in foot and ankle surgery. Rates of nonunion, wound infection and delayed bone healing were higher than in non-smokers.^[1]

If you have diabetes, blood sugar control matters, and so does nerve health. In a study of 1,465 foot and ankle operations, surgical site infection occurred in 9.5% of people with diabetes and 2.4% of those without. Neuropathy, Charcot neuroarthropathy, smoking and longer operations were each associated with infection. Peripheral neuropathy, rather than diabetes itself, most strongly predicted infection.^[2] In another study of 2,060 operations, people with diabetes complications had about a seven-fold higher risk of infection than people without diabetes or neuropathy.^[3] Your surgical team may ask you and your diabetes doctor to improve control before an elective operation. Urgent operations for infection or fracture can’t wait, and are planned around your condition.

Other steps include good nutrition, keeping other conditions such as high blood pressure under control, and treating skin problems on the foot in advance. Tell us about any skin break, infection or illness in the days before surgery, because it may be safer to postpone.

Anesthesia and pain control

Foot and ankle surgery is often done with a regional anesthetic — a nerve block, sometimes guided by ultrasound — with sedation, or with spinal or general anesthesia. The anesthesia team recommends the most suitable option for you. Modern pain plans combine nerve blocks with non-opioid medicines and, in some cases, adjuncts such as dexamethasone, which improves pain control while limiting opioid requirements.^[4] A nerve block usually numbs the foot and leg for many hours and can be extended with a catheter. In a meta-analysis of five randomized trials, a continuous popliteal nerve block lowered pain scores at 24 and 48 hours compared with a single injection, with minor pump-related problems such as leakage.^[7]

An important point: plan to start your pain medicine before the block wears off, as pain can return quickly once the numbness fades. Your team will give you a schedule.

Blood clots

Blood clots in the leg veins are a recognized risk after surgery on the lower limb, particularly when the leg is immobilized. Symptomatic clots after foot and ankle surgery are uncommon overall. The risk is higher after Achilles surgery and trauma, and in people with a history of clots, higher body weight, older age or certain medical conditions.^[5] In a study of 20,043 below-knee operations, symptomatic clots occurred in 2.5% of patients overall, and in 1.5% of those who received no preventive medicine.^[8] A Cochrane review found that injections of low molecular weight heparin reduced the risk of leg clots in people with an immobilized lower limb, though there was no clear difference in clots reaching the lungs.^[9] There is no consensus on who needs preventive treatment, and evidence to guide it is limited, so the decision is individualized.^[6]

Getting your home ready

• Plan how you’ll move: crutches, a walker, a knee scooter or a wheelchair, whichever your surgeon recommends, and practice with them beforehand.
• Set up a place to rest with the foot elevated, with what you need within reach.
• Arrange help at home for the first days, and for transport to and from surgery. You won’t be able to drive home.
• Think about stairs, bathing and where you sleep. A shower chair and a cast cover can help.
• Arrange time off work, and ask about return-to-work options.
• Buy or plan for loose-fitting footwear for the other foot and for the operated foot when it is time.

The day before and the day of surgery

You will be told the arrival time and how long to stop eating and drinking beforehand. Follow the instructions exactly, since eating or drinking when you shouldn’t can force a cancellation. Bring photo ID, your insurance card, a list of medicines, and a responsible adult who can drive you home. Wear loose, comfortable clothing, and leave jewelry and valuables at home. Operations take place at a hospital or ambulatory surgery center where Dr. Ozturk has privileges. Most people go home the same day.

When to seek care