Pre-Surgical Planning for Foot and Ankle Surgery

Welcome to our complete Pre Surgical Planning guide, and thank you for choosing the Foot and Ankle Center of Washington.

We believe strongly that surgery should be your last resort in almost all cases, and we do everything possible to avoid surgery. Our main focus has always been to provide you with the most complete information you need to safely navigate your own treatment plan. 

If your treatment plan does eventually end up requiring surgery, this page will give you a complete guide to preparing for foot surgery. 

Is it the right time for you to have foot surgery?

Often we find that many patients focus on whether or not they could have a surgery, and forget entirely to ask if they should have the surgery. Surgery is a big commitment for you, and making that decision requires partnering with the correct doctor who will help you navigate your options. 

Consider:

    • Can you take time off from work for your procedure and recovery?
    • Do you have appropriate housing where you can recover from your surgery?
    • Do you have support around the house for the time you will need to be off your feet after surgery?
    • Can you get around your house with crutches or a knee scooter?
    • Can you spend several weeks without driving if necessary for your recovery?
    • If you do smoke, can you quit for 6 weeks prior to your surgery?
    • Has your diet been sufficient to allow you to heal a surgery?
    • Can you avoid flying for a least 3 weeks after sugery?

If you’re having an elective surgery, it’s ultimately up to you when it should be performed. For most elective surgeries, there is no harm in waiting. Talk to us about all of the factors above in order to determine if it’s the right time for you to have a surgery. 

Where can I have my surgery?

We perform surgery at a specialty surgical center, or in the hospital. If you choose the Foot & Ankle Center of Washington for your surgery we will work with you to determine which surgery center or hospital, and what date is best for your schedule. 

There are benefits to both the hospital and surgical center options, luckily we are qualified and certified to operate at multiple facilities around the Seattle area. This is a major benefit to choosing the Foot and Ankle Center of Washington, and speaks to our excellent surgical reputation. Being privileged at both hospital facilities and surgical centers is difficult to achieve, and always important to look for in your surgeon. 

The hospital setting is centrally located and easy to find in Seattle. Hospitals. In the very rare circumstance that an overnight stay is required for your surgery, the hospital setting will have a place for you to stay and be monitored overnight. The hospital also has a wide variety of doctors and equipment available in the circumstance that additional consults or supplies are necessary.  Additionally, hospitals require doctors to prove that they have the education and training required to perform each procedure they request to perform at their facility. This means that you can be confident that your doctor has already proven to the hospital thoroughly that they are qualified and skilled in performing your surgery. 

The Surgery Center setting can feel like a more “boutique” approach to surgery. Surgical centers feel less like a hospital, and many people say they feel more personal. Surgery centers have lower numbers of surgeries taking place each day, and most do not take emergency surgeries. This means that your surgery will not be delayed because an emergency surgery takes priority over yours at that facility. For patient safety, surgery centers do have tight restrictions on who can have surgery at their facility. Patients with complicated health histories may be recommended to have their procedures in the hospital setting instead. 

At both facilities your surgeon will always ensure that the correct equipment is available prior to the surgery, and the correct resources are available to assist you in recovery. Your surgeon will guide you through the process of picking the best facility for you to have your surgery, with your personal well being in mind. 

In-office surgery: There are very few in-office procedures we recommend a the Foot and Ankle Center of Washington. We will perform ingrown toe nail removals and wart excisions in office, but all other procedures we perform in a hospital or surgery center. We encourage all of our patients to be skeptical of doctors that promote exclusively in-office procedures because these offices often tend to be less regulated than hospital or surgery center settings. Doctors must undergo rigorous vetting process before they are allowed to operate in a hospital setting, verses the unregulated office surgery setting.

How should I prepare for surgery?

Before surgery you will have already established with your surgeon what procedures need to be done, this may involve additional x-ray images or examinations prior to surgery. It’s incredibly important to have confidence in both your surgeon and the surgical plan you have made together. Be sure you visit our bunion surgery page to get more tips on how to find the right surgeon to perform your surgery. 

What Should I tell my doctor before surgery? 

Your doctor needs a complete picture of your health, telling them every detail is critical to the success of your surgery and healing. Specifically, be sure to mention the topics below during your pre-surgical visit. 

Allergies: 

Discuss with your surgeon any allergies you may have, specifically tell your doctor about allergies to:

    • Metals such as nickel (do you have a reaction to cheap jewelry?) or titanium
    • Shellfish 
    • Eggs
    • Medication: specifically antibiotics, lidocaine, novocaine, opioid medications, aspirin

Prior Surgeries: 

If you have ever had complications with a surgery before, be sure to let your doctor know what happened.

Medical Conditions:

Always tell your doctor if you or your family have a history of certain diseases. Specifically, some of the most important are below:

    • Rheumatoid Arthritis
    • Factor 5 Leiden
    • Hemophilia
    • Kidney Failure
    • Glycogen Storage Disease
    • Hemochromatosis
    • Ehlers Danlos Disease
    • Bipolar Disorder
    • Depression
    • Immune Suppression
    • Heart issues and any heart procedures

Tobacco Products or Drugs:

Tell your doctor if you smoke, use tobacco products, marijuana,drink alcohol or use illicit drugs, because all of these things can prevent you from healing normally. Any good surgeon will want you to quit using these products before surgery, because they care about how you heal. Be prepared to have a smoking cessation discussion with your surgeon, they can offer you guidance and assistance with the difficult but necessary process.

Medications:

You should tell your doctor about every medication you take, even herbal

 

supplements, Chinese medicine, vitamins, topical medications and caffeine consumption. 

    • You may need to talk with your surgeon about adjusting or discontinuing some medications you may be taking. 
      • Certain medications such as Non-Steroidal Anti-Inflammatory medications (e.g. Aspirin, Ibuprofen, etc…) can cause increase in bleeding and interfere with bone healing associated with your surgery. These anti-inflammatory medications will need to be stopped one week before you have your operation. 
      • Blood thinning medications (e.g. Warfarin, Xarelto, Apixaban etc…)can cause complications with your surgical procedure and will likely need to be stopped. There are risks associated with stopping blood thinners and it is imperative to talk to your surgeon about which ones and how much you are taking prior to surgery. 
      • Steroid type medications (e.g. Prednisone, Hydrocortisone, Dexamethasone ect…) can interfere with your body’s ability to heal and respond to surgical procedures and it is important to mention them to your surgeon while planning your surgery. It is rarely advised to stop steroid medications all together, rather the dose should be optimized prior to surgery for your best healing. 
      • Blood pressure medications (e.g. Lisinopril, enalapril ect…) carry the risk of lowering your blood pressure during surgery to a dangerous level if they are not monitored by both your surgeon and anesthesiologist. You many be asked to stop Lisinopril 24 hours prior to surgery.  
      • Oral Contraceptive pills: This includes estrogen supplementation as well. These medications do not necessarily need to be stopped before surgery, however you do need to notify your surgeon that you are taking them. These medications make your more likely to have dangerous blood clots during your recovery period, and special precautions are taken after surgery if you are taking these medications.
      • Herbal supplements (e.g. Ginko, Ginsing, Garlic) can change the texture and ability for your blood to clot. Your surgeon may want you to taper off of these medications prior to your surgery so that you are not taking them for up to a week before the operation. 

Diabetes management:

Diabetes certainly doesn’t need to prevent you from having a necessary operation, however it’s important to diligently manage your blood sugar around the time of surgery. This may include preparation for your surgery by optimizing your Hemoglobin A1c several months in advance. 

    • Your surgeon will want to evaluate your Hemoglobin A1C and blood sugars prior to surgery. If your A1C is too high, the surgery may be canceled or delayed. This is because consistently high blood sugar can delay healing significantly. 
    • You need to tell your doctor how you manage your blood sugar. If you are insulin dependent, tell them how much you use and how often. 
    • Tell your doctor about oral hypoglycemics (e.g. Metformin, Rosiglitazone, glipizide, repaglinide ect…) including how long you’ve been using them, how much you take, and how often you take them. You may need to hold or change your dose of these medications prior to surgery. 

How do I optimize my diet before surgery? 

Foot surgery commonly involves making cuts in the bone, in order to heal those cuts you must have a proper supply of all of the nutrients necessary. This may involve adding a multivitamin to your daily diet, and maintaining a well balanced diet for several weeks prior to surgery, and the entire duration of your recovery. 

  • Vitamin D: Vitamin D acts as a gatekeeper for calcium absorption. In order for your body to absorb calcium from your diet, you must have adequate levels of vitamin D. Recent research has shows that vitamin D is so important in calcium regulation, and bone maintenance that it may be necessary to test your blood for vitamin D levels before bone surgeries that involve bone cuts. Your surgeon may want to add this vitamin D test to your preoperative lab work if they suspect you may have low levels of vitamin D. Since Vitamin D testing is expensive your doctor may have you take Vitamin D without performing a lab test. 
  • Vitamin C: Several scientific studies have correlated vitamin C supplementation with reduced risk of nerve damage and dysfunction after surgery. 
  • Calcium: Your bones need adequate levels of calcium to strengthen and heal properly.
  • Protein: Healing your skin requires a steady intake of protein. This can be achieved by eating a balanced diet prior to surgery, or supplementing with a complete nutrition supplement. 
  • Iron: Iron is important for the transport of oxygen in your blood. Oxygen is essential for healing your surgical wounds. You can get your daily iron requirements from a balanced diet, or from a daily multivitamin. 

If you need help choosing a multivitamin, vitamin supplement, or formulating a well balanced preoperative diet, never hesitate to tell your surgeon. As your doctor, they will be happy to guide you when making these diet changes, or even refer you to a registered dietitian for a complete workup. It is important not to diet after surgery so make sure you have adequate nutrition. 

What physical exams do I need before surgery?

Before your surgery you will need to visit your Primary Care Physician, who will take a complete medical history and perform a physical exam to ensure it is safe for you to have surgery. This appointment needs to happen within one month of your surgery. 

    •  Depending on your unique health situation it may be necessary to have additional studies done such as a blood draw for lab work, an EKG for your heart, or a chest x-ray. 

How do I prepare for my recovery?

You will need time off of work.

Depending on what surgery you had and what you do for a living, you may need 5-7 days, to several weeks off of work. Jobs that require standing, lifting, walking or other strenuous activities will need additional time off. Some jobs you can perform while seated can be resumed within a week of your surgery. 

You will need to plan some down time for your recovery.

  •  Surgery is a big step and it’s important to plan enough recuperation time for you to recover. How much time exactly will depend on which procedures you need to have performed on your foot. 
  • You may need help preparing meals for yourself, caring for family members, running errands and moving about the house. 
  • Try to have at minimum a few days of meals prepared for yourself to simplify your recovery. 
  • Try to have a support system of family members that can assist you during your recovery after surgery. 

What do I need to buy for my surgery?

Surgery Soap: 

You’ll need to wash with a specific type of soap the night before and the morning of surgery. It’s important to be thorough with the surgical soap to reduce your risk of infection. 

Crutches or a knee scooter: 

For most foot surgeries you won’t be able to put weight on your foot for 2-4 weeks after surgery, this can be significantly longer if bone cuts are made. Be sure to read our knee scooter guide if you haven’t already. 

  •  You may want crutches, which need to be the correct size for you. Proper crutches should rest 3 finger widths below your armpit when standing. Your elbows should be bent. Remember the weight is on your arms not armpits. If you’re unsure if the crutches you own will fit you, bring them to your doctors office and they will check.
  •  Another option is a knee scooter which may require some practice. If you have a bad back, or bad knees, the knee scooter may not be the best option for you. 

Ice Pack: 

It’s important to purchase the right kind of ice pack. Some ice packs provide too much cold to the area you put them on, and can actually harm the skin. A medical ice pack specifically designed to conform to your limb is preferable. You can find a reasonably priced gel ice pack here on amazon. Alternatively, a bag of frozen peas wrapped in a towel will conform to the limb and provide the ideal time frame of cold exposure that we recommend. Make sure you do not constantly ice or you may freeze your skin. 

How will I know  where to go on the day of my surgery?

In addition to the information we give you, the surgical center or hospital where you are having your operation will also call you the week before your surgery. They will tell you where you should go for your procedure, and what time to arrive. 

They will also remind you to wash with the pre-surgical soap, not eat any food starting 8 hours prior to arrival time, and take only the medications you discussed with your surgeon and primary care doctor with a sip of water the morning of surgery. You may be able to have clear fluids and black coffee, no milk, up to 3 hours prior to arrival time but make sure you check with your physician (usually in your paperwork). 

What will happen on the day of my surgery?

On the day of surgery you will arrive at the hospital or surgical center in advance of your surgical start time. A member of the team from the hospital or surgical center will call you before your surgery date and give you all the information about where to go and what time exactly to arrive. 

You will change into a surgical gown and you’ll be given a hair net. The anesthesiologist will meet with you before your surgery, and an IV will be started. 

Once in the operating room the anesthesiologist will start your anesthesia and you will drift off to sleep. You won’t feel any pain during your surgery and you may not remember any part of the surgery. If you are having a surgery on the back of your heel, after anesthesia is started the operating room team will maneuver you safely onto your stomach for the operation. This will be fully discussed with you before your surgery date.

Do I need to set up any doctors appointments for after my surgery?

Before your operation you will need to set up 2 follow up appointments with your surgeon to check on the progress of your healing. The first appointment will be 5 days after your surgery, and the second will be around 2 weeks after your surgery. 

    • If you have questions or concerns at any point in time before your surgery don’t hesitate to call us.

What complications could occur?

All surgeries come with some risks. In general, complications are rare and you can reduce your risk of experiencing these complications by following your surgeon’s instructions before and after your surgery.  The best way to have a good outcome is by following your surgical plan and communicating with your doctor openly about your concerns or limitations. 

Here are a few of the most common complications of foot surgery:

Pain following your operation

  • Here at the Foot and Ankle Center of Washington we have years of experience managing post operative pain. We have a detailed pain management plan for each person and the best way to minimize your pain is by following your doctor’s recommendations after surgery. 
  • At a minimum, your surgeon will encourage
    • Icing the surgical site, and behind the knee
    • Protecting the surgical site
    • Elevating the limb – 1 to 2 pillows
    • Carefully prescribed appropriate pain medications 

Infection of the surgical site

  • Because we require you to come into the office for routine check up visits following your surgery, infection is almost always caught early. If we detect the early signs of infection we will start you on the appropriate antibiotic to combat the infection. Most infections can be successfully treated with antibiotic pills, proper hygiene and careful management by your surgeon. 
  • Signs of post operative infection include:
    • Fever
    • Chills or shaking
    • Nausea
    • Vomiting
    • Redness and temperature around the bandage or surgical site
    • Unusual drainage from the surgical site
    • Swelling of the foot or leg
    • Significantly increased pain
  • Reduce your risk of infection by following the doctors recommendations carefully after surgery. It’s very important to keep your surgical site clean, dry and covered with bandages until 4 weeks after surgery. Most infections can be avoided by patient compliance after surgery.
    • You should always contact your doctor if the bandage over your surgical site: becomes wet, falls off, or you can see blood or fluid leaking through. 

A blood clot in your leg

  • This is exceedingly rare, however it is crucial to be aware of the symptoms of a blood clot and call your doctor immediately once you recognize you are experiencing them. 
  • While recovering from surgery your body, and specifically your leg, is holding still for significantly longer than it is accustomed to. While your body is not moving the blood flow around your body can slow and pool, causing blood clots to form most often in the calf and leg on the side where the surgery was performed. Thus, it is important to move your limbs and move from one room to another after surgery to promote blood flow. Your doctor may have you take a blood thinner after surgery. 
  • Symptoms of blood clots include
    • Pain in the calf or thigh of the leg
    • Swelling of the foot, calf or thigh
    • Redness of the foot, calf or thigh
    • A tight feeling in your chest
    • Difficulty breathing
    • Dizziness
  • If you have any chest pain after surgery immediately go to the emergency room. If you notice any leg swelling consult your surgeon.

The bone cut could fail to heal or heal in the wrong position

  • In any surgery that involves cutting the bone, there is always a risk of the bone not healing back together in the proper position or at all. While this is a very rare circumstance, it has been known to occur and that is why your surgeon will take x-rays of the surgical site at every follow up visit after your surgery.
  • Many people who’s bone cut doesn’t properly have no symptoms at all, and are still happy with their surgical result. However, some patients who do not heal the bone cut may also notice pain beyond 6-8 weeks after surgery, redness, and swelling. 
  • If there is evidence that the bone is not healing properly it will prolong your recovery time and may even require a second operation to correct the poorly healing bone. 

Medical References:

Chen S, Roffey DM, Dion CA, Arab A, Wai EK. Effect of Perioperative Vitamin C Supplementation on Postoperative Pain and the Incidence of Chronic Regional Pain Syndrome: A Systematic Review and Meta-Analysis. Clin J Pain. 2016;32(2):179‐185. doi:10.1097/AJP.0000000000000218

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