Recently I wrote a blog on pre-operative tips before having foot and ankle surgery, and I got many requests to write about what to do after foot surgery.  These are general tips, and different procedures may require more individualized instructions.  Make sure your podiatrist gives you instructions for your specific needs.  Your actions the first 48-72 hours after surgery are critical to your healing and comfort.

Medications:  Take all prescriptions as directed.  Do not use any other medications including aspirin, Tylenol, or Ibuprofen unless you have consulted your podiatrist first.  Most patients will be given pain medication and antibiotics to help prevent infection.  Pain medications may cause constipation and you may want to discuss taking a stool softener with your doctor.  Do not drive or use dangerous equipment while taking pain medication.  Finish all antibiotics given as directed.

Walking:  Depending on what procedure you have, your podiatrist will tell you to stay off your foot for at least 48-72 hours following surgery.  You should limit your walking to just the bathroom during this time.  Some procedures require you to be non-weight bearing on crutches.  This is extremely important and means no weight on the foot at all, sometimes not even resting the foot on the floor while not walking.

Elevation:  The more you keep your foot elevated the less pain and swelling you will have.  If not elevated, you may feel throbbing pain and the bandages may feel tight.  Elevation above the heart is key. While lying down place 2 pillows under the foot; this is usually enough to get the foot above the heart.  It is important to keep your foot or ankle elevated whenever you are not on it. If you can keep it elevated for more than 48-72 hours you should do so.

Post-Op Shoe/Boot:  Always wear the post-op shoe or boot that is dispensed to you whenever you are walking.  Walking without the shoe/boot will cause damage to the surgical site and will cause an increase in pain, and the procedure may not heal correctly.

Keep Bandages Clean and Dry:  The bandages are in place for a purpose and will help to hold the surgical correction in place so it can heal.  If you get the bandages wet, your infection chances increase.  To help keep the bandages dry, get a waterproof cast protector usually available from your podiatrist’s office.  If your podiatrist’s office does not carry them, any medical supply house will have them.  Trash bags with tape do not work, so please do not use them.  The cast protector will fit over your shoe or boot and should be used every time you bathe.  Never remove the bandage without contacting your doctor’s office.

Ice:  Ice should be used for 48-72 hours following your procedure.  If using re-usable ice packs have two so one can be freezing while the other is being used.  Ice should be place on the foot or ankle for 20-30 minutes per hour during waking hours only.  You do not have to use it during the middle of the night.  Some podiatry offices use cold machines which work on their own, and you will be shown how to use it prior to or directly after surgery.  Ice will help reduce pain and swelling.

Blood:  It is normal to notice some blood on the bandage, so do not become alarmed if you see a small amount.  Free-flowing blood is not normal, and you should contact your surgeon’s office immediately.

Feeling Dizzy:  It is normal to feel dizzy or lightheaded the first few days following surgery.  If possible, use assistance when walking.  If you have been lying down, sit up slowly and remain sitting with your feet over the edge of the bed for at least one minute before standing.

Numbness:  The local anesthetic used during the surgery may last up to 48 hours.  This means you may not feel anything or be able to move your toes for this time period.  The numbness may make it hard to feel the effects of not following the directions.  If you have not elevated your foot above your heart, not walked only to the bathroom, not used cold to minimize swelling, or not taken your medication as prescribed, you may have more discomfort than anticipated once the anesthetic has worn off.

Swelling:  You will get a certain amount of swelling following any foot or ankle surgery.  Elevation above the heart will help reduce this.  If the bandage or cast feels too tight, touch the end of your toes to see if they blanch white then pink within a few seconds.  If so, then this is normal.  If it takes longer for the normal color to return or a blue color is noted, call your doctor’s office immediately.

Prevent Blood Clots:  Unless you are in a cast, it is good to move your foot at your ankle for a few minutes each hour.  If you feel severe pain to the back of the leg, knee, or upper leg with redness and heat call your surgeon’s office right away.

Fever:  It is normal to run a low-grade fever for up to 72 hours following surgery.  If the fever persists or exceeds 100 degrees, call your doctor’s office.

Keep all appointments:  It is essential to keep all follow up appointments with your podiatrist to ensure you are healing properly.  Redressing may be performed to your foot or ankle.

These are general tips to follow.  Your foot and ankle surgeon will likely give you his or her own written instructions.  If you have any questions at any time, you should contact your doctor.  As Dr. Bowman always tells his patients, “no question is too stupid to ask.”

Dr. Bowman at Houston Foot Specialists can be reached at www.houstonfootspecialists.com or by calling 713-467-8886

Having foot or ankle surgery is not as bad as some make it out to be if you are prepared.   In this blog, you will learn some tips from foot and ankle surgeon Dr. Jeffrey Bowman and Houston Foot Specialists.

First, and most important is to ask your podiatrist before the procedure any questions you may have.  If your podiatrist has written orders for lab work, X-rays, or MRI, have them done in advance so your foot and ankle surgeon is prepared -  and, yes, surgeons have to prepare just like the patient.

Tips for Before Surgery:

Have a cooler set up by the bed or couch with ice packs and food and drinks so you don’t have to get up and down.

Have a waterproof cast cover to keep your foot dry when you bathe.  Trash bags with tape do not work, and if your bandage gets wet your chance of infection increases.

If you are on blood thinners, aspirin, or ibuprofen, stop taking it at least 5 days prior to surgery unless your doctor specifically authorizes its use.

If your surgery requires crutches, get them in advance to practice using them.  Your podiatrist or staff can show you how to get used to them.

If given a post-op shoe or a walking boot, make sure you bring it with you to surgery.

Have all prescriptions filled before the surgery.

Remember, do not have anything to eat or drink after midnight the day before the surgery.

Tips the Day of Surgery:

It is normal to be nervous the day of surgery.  The surgery center or hospital will give you something to help with this.

Wear loose fitting clothing.

If advised, take any medications you normally take with just a sip of water.

Do not wear any jewelry, makeup, nail polish, body piercings, contacts leases, or dental appliances.

If you have any metal in your body, make sure you tell the pre-op nurse.

Leave all valuables at home.

Bring photo ID (such as your driver’s license) and health insurance card with you.

Bring your post-op shoe or walking boot if given one.  Some doctors have them at the surgery center or hospital for you.

Have a friend or family member with you to drive you home.

Most foot and ankle surgeons will have written post-operative instructions with do’s and don’ts.  Make sure to read these before your surgery and have them handy after.  If you follow the instructions carefully, you will have much less post-operative pain, swelling, and chance of complications.  Every patient is different, so your instructions may be tailor-made for you.

Your recovery will go more smoothly if you are prepared before surgery. If you have any questions, it is important to ask before surgery.   Dr. Bowman is available to answer any questions you may have.

As we enter the holiday and winter season, many of us will be attending Holiday parties, eating and drinking with our co-workers, friends and family.  Soon after these parties many of you will be seeing your podiatrist because of severe pain to your joints in the foot and ankle.

Gout is one of the most painful forms of arthritis that occurs in the foot.  It occurs when too much uric acid builds up in the body from excessive digestion of rich foods and alcohol.  Gout usually starts with a sudden onset of intense pain in one or more of the joints; most common is the big toe. The joint is accompanied by pain, swelling, redness, heat and stiffness in the joints.  For most people the first attack wakes a person from sleep and typically there is no recollection of injury to the joint prior to the onset of pain.

While symptoms usually occur in the big toe joint, any joint may be involved.  Other common sites are the instep of the foot, the ankle and the knee.  When the foot is involved, wearing shoes id very difficult and painful, as are attempts to move the joint or stand on the foot.  Seeking treatment and early diagnosis form a podiatric physician is crucial as gout can cause damage and in serious conditions, disability in the affected area.

If the attack is in the toe, elevate the foot, avoid standing and walking, and wear only a loose slipper until seen by a podiatric physician.  In general, treatment for gout works by reducing the levels of uric acids in the body.  Dr. Bowman’s first line of treatment is administering NSAID’s or Non-Steroidal Anti-Inflammatory Drugs and often a blood test to measure the amount of uric acid in the body.  Some corticosteroids (oral or injection) may be prescribed as well.  Certain medications to lower the levels of uric acid may be also be given.

If Gout attacks continue despite the treatment, excessive deposits of gouty crystals or Tophi within the joint, or if arthritis causes continual discomfort, surgical treatment by Dr. Bowman may be necessary to remove the crystals and repair the joint.

Your Podiatrist may prescribe the following general foot care tips during treatment of gout.  These tips will help in relieving and avoiding pain during recovery.  These will also help in prevention of future attacks from taking place:

    -    Ensure your feet are comfortable by wearing appropriate foot wear.  Shoes with ample space for the toes to move and they should fit properly.

    -    Avoid activities that put stress on the joints such as standing for long periods of time.

    -    Do stretching of the feet regularly; this will assist in strengthening of the affected joints and promote increased blood circulation.

    -    Eating a healthy gout diet; this mainly involves a reduction of foods and alcohol that have a high concentration of purines (i.e. liver, red meats, dried beans and peas, etc.) while trying to substitute them with alternative foods.   Dr. Bowman can give you a list of foods to avoid.

    -    Try to maintain a healthy body weight, as being overweight may result in stress and pressure being exerted on joints located in the feet.  The stress and pressure may also cause pain and slow down the gout treatment you are undergoing.

Gout is one of the most painful medical conditions known.  For further information or to get your questions answered feel free to contact Dr. Jeffrey N. Bowman at www.houstonfootspecialists.com or by calling Houston Foot Specialists at 713-467-8886.

You may have recently seen television ads regarding “Minimally Invasive Bunion Surgery” or “Mini Bunionectomy.”  This is a procedure available at Houston Foot Specialists performed by Dr. Jeffrey Bowman.

The first step in evaluating whether the Mini Bunionectomy is right for you is to understand what causes the bunion or “Hallux Abducto Valgus” deformity. The space between the first and second metatarsal bones (the long bones in your foot) is called the Inter-metatarsal angle or “IM angle”.  As the angle increases, so does the growth at the base of the big toe (Hallux) from shoe pressure.  The big toe usually drifts toward the second toe, sometimes overlapping or underlapping the second toe.  Some of the factors causing this include weak ligaments, trauma, improper fitting shoes, tight high heels, flat feet, and hereditary factors.  When bunion pain first starts, it should be treated conservatively.  If this fails, then surgery is usually indicated.

There are numerous bunion procedures, and your podiatrist will take X-rays and perform a biomechanical exam to determine which procedure is the one that is correct for you.  The bone enlargement is removed in all procedures and the big toe is placed in a straighter position.  

Most bunion procedures are named after the surgeon who developed them.  One procedure that isn’t named after a doctor is the minimally invasive procedure called the “Mini-Tight Rope” procedure.  It is extremely important that a patient realize this procedure is not meant for everyone.  As with any surgical procedure, complications could develop.  Your podiatrist will determine whether you are a candidate for surgery and whether the “Mini-Tight Rope” procedure is right for you.  What does the “Mini-Tight Rope” procedure involve?  Two small incisions are made: one to remove the enlarged bone at the base of the big toe, and the second incision is placed over the second metatarsal.  Next, a very strong type of suture is placed into the first metatarsal then passed through the second metatarsal to pull the first metatarsal over toward the second, in essence narrowing the foot.  This is secured in place by two small “buttons” on either side of both bones.  A shift is needed in all procedures to help minimize any return of the foot deformity and again, your podiatrist will determine if this procedure or another is better to correct your bunion.

If you suffer from pain at the base of the big toe or Bunion Deformity, please see your podiatrist.  At Houston Foot Specialists, we perform and are experienced in all types of bunion procedures.  Contact us at www.houstonfootspecialists.com for details and ask a question on our “Contact Us” page.  Or, you may call Dr. Bowman at 713-467-8886, and one of our caring and friendly staff members will be glad to help.  Our goal is to stop your foot pain and get you back into all the shoes you want to wear with comfort!