Recovery after foot and ankle surgery

The phases of recovery

Every operation is different, but most recoveries follow a similar pattern.

The first days. Rest with the foot elevated above the level of the heart as much as you can, keep the dressing clean and dry, and take pain medicine on the schedule you were given. A nerve block can wear off suddenly, so start your pain medicine before that happens. Follow your surgeon’s instructions about whether you may put any weight on the foot and which device to use: crutches, a walker, a knee scooter or a boot.

The first weeks. Stitches are usually removed after about two weeks, dressings are changed or removed, and a splint may be replaced with a boot or a cast. Depending on the operation, you may begin gentle motion exercises.

Weeks to months. Weight-bearing is increased in steps, a boot is replaced by a supportive shoe, and physical therapy focuses on motion, strength, balance and walking. Swelling can persist for months, and it usually is worse at the end of the day.

Returning to full activity. Sports and impact activities come last, and they depend on strength, motion and pain rather than on a date.

Weight-bearing: why plans differ

Weight-bearing protocols are among the most variable parts of recovery, because they depend on the operation, the bone quality, the fixation and the surgeon’s judgment. Some examples from the research:

• Hammertoe surgery. Walking in a protective shoe may be allowed right after surgery.^[1]
• Ankle fractures. In a Cochrane review, starting to bear weight early (within about three weeks) probably led to somewhat better ankle function than delaying it, though not by a clinically important amount. After surgery, a removable ankle support may lead to better function than a non-removable one.^[6] Most ankle fractures take at least six weeks for early healing and 10 to 12 weeks for complete healing.^[2]
• Achilles repair. Early functional rehabilitation in a brace, with motion and weight-bearing, was as safe as a cast and gave higher satisfaction.^[7]
• Lapidus bunion fusion. Studies of early weight-bearing report a nonunion rate of 3.6%; a longer time to full weight-bearing correlated with nonunion in a meta-analysis.^[8,9]
• Ankle ligament repair. Early movement was associated with better functional scores, and also with slightly more laxity and complications, than later movement.^[10]

Never let a friend’s or another patient’s experience override your own surgeon’s instructions; a different operation calls for a different plan.

Typical timelines

These are general ranges, not promises. Yours will be set by your surgeon.

• Lesser-toe (hammertoe) surgery: stiffness and swelling for about four to six weeks.^[1]
• Ankle fracture: at least six weeks for early healing and 10 to 12 weeks for complete healing.^[2]
• Lisfranc (midfoot) injury: six months to a year to resume all activities.^[11]
• Flatfoot reconstruction: typically six months or more before healing is complete.^[3]
• Surgery for arthritis of the foot and ankle: full recovery can take four to nine months.^[12]
• Surgery for Achilles tendinopathy: up to a year of rehabilitation.^[13]

Driving and returning to work

Driving. A review of studies on returning to driving after orthopedic surgery found that objective measures of braking response often returned to normal weeks after the operation, that patients frequently start driving before those measures have normalized, and that factors such as strength, range of motion and opioid use also matter.^[14] As a rule, don’t drive while you are taking opioid pain medicine, while you are in a boot or cast on the foot you use to brake, or until you can brake firmly and quickly in an emergency. Ask your surgeon before you resume driving.

Work. Return-to-work timing depends on your job. Desk work with the foot elevated may be possible within days to weeks; standing, walking or physical work usually takes longer. Tell us about your job before surgery, so the plan can include work notes, a graduated return or modified duties.

Preventing problems

• Wound care. Keep the incision clean and dry, and don’t soak until you’re told you may. Don’t use creams or ointments on it unless instructed.
• Blood clots. Immobilization of the leg raises the risk of clots in the leg veins. Your surgeon will discuss your individual risk and whether medicine or other measures are appropriate.^[4,5,15] Signs include calf pain, swelling or tenderness, warmth and redness of the leg.
• Smoking and diabetes. Both increase the risk of wound problems and delayed healing after surgery, so avoiding tobacco and keeping your blood sugar under control matter throughout recovery.^[16,17]
• Movement and exercise. Unless you’re told otherwise, move the toes and the joints above the operated area, and do the exercises you are given. Physical therapy helps recover motion, strength and balance.^[6]
• Scars. Once healed, massaging the scar may help to soften it, if your surgeon agrees.
• Numbness and tingling. Some numbness or altered sensation around the incision is common and often improves with time. Tell us if it is severe or worsening.

When to seek care

Call the office promptly if something doesn’t feel right. Don’t wait for your next scheduled visit.