For patients that recently have had a procedure done in the office or at the hospital:
For most foot and ankle procedures there are a few things that may help in the post-operative period to relieve pain:
Ice and Elevation
Elevation is essential during the immediate post-operative period for nearly all surgery of the foot and ankle. The body will undergo a hyperemic (increase blood flow) response to any injury whether it be surgically created or traumatically. The body doesn’t know the difference. This edema (swelling) can cause tension on the incision, skin and soft tissue. In more serious cases blood clots can form further complicating the issue. If you feel extreme pain in your calf, call the office immediately. Appropriate level for elevating your foot should be when the foot is the same or higher than the knee.
Ice is extremely helpful in decreasing the pain post op. The cold constricts the blood vessels and decreases the hyperemic response. Do not put the ice directly on the skin but a plastic zip lock bag with a towel works well. Ice can be placed directly over the surgical site the bandage will also act as a barrier to cold and may not provide effective cooling. If you have a boot or cast, place the ice behind your knee. It will cool the blood as it travels toward your toes.
Opiates – Medications in the opiate class are powerful relievers of pain. The use of them should be reserved for acute trauma or post-operative pain to which they are effective and necessary. Inappropriate use outside of these clinical scenarios can lead to severe addiction problems. These meds should only be taken when prescribed by a physician. When taking them make sure to have food in your stomach.
Do not drink alcohol while taking these medications Most patients will have a peripheral nerve block to help deal with the immediate post-op pain. These blocks will usually where off around 6 hours after the surgery. Take your medication 5 hrs after surgery and every 4-6 hrs until your first follow-up. If you notice a rash, severe nausea or no pain relief, call the office immediately. These medications will typically cause varying degrees of constipation (stool hardening). A stool softener may be necessary if symptoms persist
NSAIDS – Common Medications in the NSAID class include Ibuprofen, Naprosyn, Meloxicam and Diclofenac. These medications are anti-inflammatory agents and can provide adequate relief. There are certain Cardiac, Gastric and Renal contraindications to the use of these medications. Make sure to disclose a full history to the operating physician and do not exceed the daily allowed dose. Make sure to eat before taking these medications.
Many times an antibiotic is prescribed for a 3 day postoperative course. These are typically a cephalosporin and are not recommended for patients with a Penicillin allergy. If severe nausea, rash or fever is noted call the office immediately. Staggering your antibiotic with your other post-op medications is preferable to prevent GI upset.
The type of procedure will dictate the amount of pressure that can be applied to a foot and this should be discussed in detail before surgery. If you are unsure then avoid putting weight on your foot and call the office during normal office hours for clarification. Do not remove the surgical shoe, boot or cast.
If you feel unsteady on crutches or uncomfortable in the immediate post-op period then try and avoid showering until you’re comfortable and make sure you have help. Please do not get your bandage wet. Most surgeries require the bandage to stay clean dry and intact. The exceptions include infections and wounds which should have their own instructions. If you are unsure of the dressing orders please call the office. If you are committed to showering then make sure to properly waterproof your bandage. Surgical gloves may work well if you have had a procedure down near your toes or forefoot (front of your foot). Make sure to double tape the edges to create an effective seal. This is also true if you have a bigger device that goes around the calf or thigh. If you accidentally get your bandage or cast wet call the office during normal hours to schedule a change.
If pain continues then it is possible the bandage may be too tight. A tight bandage can strangulate the foot and cause varying degrees of edema and ischemia. If your toes are extremely swollen, attempt to loosen the bandage by unraveling the outer layer. This will usually release pressure and provide relief. Do not undress the bandage down to the skin. If pain has not reduced or you notice that your toes are white, call the office immediately.