post surgery

Information

Most of the surgery that we perform requires immobilization afterward, and each type has a different recovery time. Ligaments and bones take an average of 6 weeks to heal depending on the health of the individual, so we immobilize the leg to make sure the repair stays together. Next, we allow progressive weight-bearing and motion in phases to allow the tissues to heal. Physical therapy is then prescribed to rehabilitate our patients back to strength and function. We follow five specific protocols that have proven effective for our patients. As physicians, we also reserve the right to adjust our protocols as needed to individualize the treatment to each patient.

Minor Procedures                                   & Standard Protocol

• Ankle Arthroscopy
• Ankle Hardware Removal
• Ankle Arthrotomy/Synovectomy
• Plantar Fascia Microtenotomy
• Isolated Gastrosoleus Recession
• Mass Excision
• Tarsal Coalition Excision
• Midfoot Exostosis Excision
• Dorsal Foot Nerve Decompression

These ankle surgeries are considered more minor and have the advantage that most patients can walk much sooner. Because we find that our patients are careful during the recovery time, we allow our patients to put full weight on their ankle after their first post-op visit.

Between Surgery and first follow up appointment: Keep the postoperative dressing dry. Elevate the leg for comfort. Ice for comfort.
Follow up to the office 5 to 10 days after surgery: Removal of postoperative dressing. Removal of sutures.
3-4 weeks in a boot walker with full weight-bearing. This is taken on and off to shower/bathe and sleep. Motion is encouraged when the boot is taken off. Remind the nurse to consider a compression stocking if you are having trouble with swelling.
4-6 weeks of physical therapy if your doctor feels it is necessary. Careful attention in Physical Therapy will help bring back strength, motion, and flexibility.
Shoewear, Orthotics, Bracing and splinting recommendations will be addressed as you progress to normal daily activities.

Forefoot Procedures

• Bunion Surgery (except TMT fusion – midfoot procedures)
• Hammertoe Surgery
• Weil Osteotomy
• Plantar Plate Repair
• Flexor/Extensor Toe Tenotomies
• Excision Interdigital Neuroma
• Cheilectomy & Interposition Arthroplasty
• 1st Metatarsal Fusion
• Bunionette Surgery
• Foot Hardware Removal

Forefoot surgery has the advantage that most patients can walk on their heels. Because we find that our patients are careful during the recovery time, we allow our patients to put full weight on their heels after their first post-op visit.

Between Surgery and first follow up appointment: Keep the postoperative dressing dry. Elevate the leg for comfort. Ice for comfort.
Follow up to the office 5 to 10 days after surgery: Removal of postoperative dressing. Removal of sutures.
4-5 weeks in a boot walker with full weight-bearing. This is taken on and off to shower/bathe and sleep. Motion is encouraged when the boot is taken off. Remind the nurse to consider a compression stocking if you are having trouble with swelling.
4-6 weeks of physical therapy if your doctor feels it is necessary. Careful attention in Physical Therapy will help bring back strength, motion, and flexibility.
Shoewear, Orthotics, Bracing and splinting recommendations will be addressed as you progress to normal daily activities.

Midfoot Fusions & Fractures

• Lateral Column Lengthening Procedure
• Posterior Tibial Tendon Repair with Calcaneal Osteotomy (Flatfoot Reconstruction)
• Lisfranc fractures (tarso-metatarsal fractures)
• Subtalar Fusions
• Metatarsal Fractures
• Midfoot Fusions
• Tibialis Anterior Tendon Repair
• Cavovarus Foot Reconstruction
• Complex Ankle Fractures

These procedures are yet more involved and require a period of non-weight-bearing to allow ligaments, tendons and bone to heal. With increasing surgical complexity, we require non-weight-bearing for a longer duration. Progressive weight-bearing is then initiated to accelerate remodeling of the bone and to improve its compression and tensile strength.

Between Surgery and first follow up appointment: Keep the postoperative dressing dry. Elevate the leg for comfort. Ice for comfort.
Follow up to the office 5 to 10 days after surgery: Removal of postoperative dressing. Removal of sutures.
3 weeks in a fiberglass cast non-weight-bearing. No weight-bearing activities are allowed: no walking, standing, or balancing on the cast. Crutches, a walker, turning leg caddy, or a wheelchair is needed.
3 more weeks in a fiberglass cast non-weight-bearing. No weight-bearing activities are allowed: no walking, standing or balancing on the cast. Crutches, a walker, turning leg caddy, or a wheelchair is needed.
4-6 weeks in a boot walker. This initiates a gradual increase to full weight-bearing as pain and swelling allow. The boot is taken on and off to shower/bathe and sleep. Motion is encouraged when the boot is taken off. Remind the nurse to consider a compression stocking if you are having trouble with swelling.
4-6 weeks of Physical Therapy. Careful attention in Physical Therapy will help bring back strength, motion, and flexibility.
Shoewear, Orthotics, Bracing and splinting recommendations will be addressed as you progress to normal daily activities.

Ankle Procedures

• TMT Fusion for Bunions
• Brostrom Repair/Ankle Stabilization
• Ankle Arthroscopy with Repair of Osteochondral Defect
• Peroneal Tendon Repair
• Tendon Transfers
• Simple Ankle Fractures
• Repair Achilles Tendon with or without Partial Excision of Calcaneus
• Tarsal Tunnel
• Total Ankle Replacement
• Achilles Tendon Lengthening

These procedures are a little more complex and require a period of non-weight-bearing to allow ligaments, tendons and bone to heal. Because we find that our patients are careful during the recovery time, we allow our patients to begin range of motion after the post-op casting.

Between Surgery and first follow up appointment: Keep the postoperative dressing dry. Elevate the leg for comfort. Ice for comfort.
Follow up to the office 5 to 10 days after surgery: Removal of postoperative dressing. Removal of sutures.
3 weeks in a fiberglass cast non-weight-bearing. No weight-bearing activities are allowed: no walking, standing, or balancing on the cast. Crutches, a walker, turning leg caddy, or a wheelchair is needed.
4-6 weeks in a boot walker. This initiates a gradual increase to full weight-bearing as pain and swelling allow. The boot is taken on and off to shower/bathe and sleep. Motion is encouraged when the boot is taken off. Remind the nurse to consider a compression stocking if you are having trouble with swelling.
4-6 weeks of physical therapy if your doctor feels it is necessary. Careful attention in Physical Therapy will help bring back strength, motion, and flexibility.
Shoewear, Orthotics, Bracing and splinting recommendations will be addressed as you progress to normal daily activities.

Complex Hindfoot Procedures

• Ankle Fusions
• Double or Triple Fusions
• Pantalar Fusions
• Tibio-talo-calcaneal Fusions
• Talo-navicular Fusions
• Talar Fractures
• Calcaneal Fractures
• Pilon Fractures

These bony procedures require the most immobilization. Bones on the average take 7 weeks to heal to about 80% of their normal strength. Once healed, we progressively stress the bone to accelerate remodeling of the bone and to improve its compression and tensile strength.

Between Surgery and first follow up appointment: Keep the postoperative dressing dry. Elevate the leg for comfort. Ice for comfort.
Follow up to the office 5 to 10 days after surgery: Removal of postoperative dressing. Removal of sutures.
3 weeks in a fiberglass cast non-weight-bearing. No weight-bearing activities are allowed: no walking, standing or balancing on the cast. Crutches, a walker, turning leg caddy, or a wheelchair is needed.
3 more weeks in a fiberglass cast non-weight-bearing. No weight-bearing activities are allowed: no walking, standing or balancing on the cast. Crutches, a walker, turning leg caddy, or a wheelchair is needed.
3 weeks in a weight-bearing cast. Full weight-bearing with no assistive devices is allowed. It will take time to adjust to walking in a cast. Ice and elevation remain important as you increase your activity level.
4-6 weeks in a boot walker. This initiates a gradual increase to full weight-bearing as pain and swelling allow. The boot is taken on and off to shower/bathe and sleep. Motion is encouraged when the boot is taken off. Remind the nurse to consider a compression stocking if you are having trouble with swelling.
4-6 weeks of physical therapy if your doctor feels it is necessary. Careful attention in physical therapy will help bring back strength, motion, and flexibility.
Shoewear, Orthotics, Bracing and splinting recommendations will be addressed as you progress to normal daily activities.

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