Signs Of A Problem After Foot Surgery

Your surgeon and your care team will be the best resource for information about what to expect and what could suggest that there is an issue during your recovery from foot surgery, but here’s a look at a few things you might want to discuss with your care team if they develop during your recovery.

1. Scar Problems – If you’re dealing with some weird symptoms at the surgical site, you’ll want to connect with your care team. Some redness, discharge and tenderness is normal following the trauma of surgery, but expanded redness, discolored discharge, foul-smelling discharge or intense pain at the wound site are potential signs of an infection. Be sure to reach back out to your care team if you’re experiencing any of these symptoms at your surgery site.

2. Fever – A fever is another sign of a potential infection. If your temperature has risen above 100 degrees and you’re experiencing other signs of a fever – headaches, chills, loss of appetite – call your doctor. Infections can compromise the integrity of your operation and even be deadly, so it’s imperative you try to snuff out an infection at its earliest stage.

3. Worsening Pain – Pain is typically at it’s worst 24-48 hours after the operation. This is when trauma if the freshest and you’re still figuring out the best way to manage discomfort with painkillers, so it shouldn’t be a surprise that the pain seems most intense at this stage. However, if days or weeks go by and your pain levels remain high, or they end up worsening, you’ll want to consult with your care team about the next steps to take.

4. Calf Pain and Swelling – Again, some swelling is likely expected in the short-term after your surgery, but prolonged or unexpected swelling could be a sign of an issue, especially in your calf area. Pain and swelling in your calf could indicate a blood flow issue, like a clot. Blood clots can be more common following a surgical procedure that’s coupled with limited movement in the days that follow. Watch for signs of a blood clot and talk with your care team if you notice anything odd.

5. Numbness – Finally, numbness is an issue you’ll want to watch out for following a surgical procedure. If your foot is in a cast or walking boot, numbness in a toe could signify that the device is preventing ideal blood flow. Talk to your doctor about any numbness or sensory loss you’re experiencing after a foot or ankle surgery.

Don’t hesitate to reach out if any of these issues develop following a surgical procedure. For more tips, or to talk to a specialist about your foot situation, connect with Dr. Silverman and his team today!

The post What’s Not Normal During Recovery From Foot Surgery? appeared first on Lance Silverman, MD - Orthopedic Foot & Ankle Surgeon.

Is there a way to know for certain that foot or ankle surgery will be worth it ahead of time? We don’t like to speak in certainties, but their are aspects of your life that you can evaluate that can help you better understand if surgery will likely be worth it in the long run. We spotlight some of those factors in today’s blog.

Determining If Foot Surgery Is Worth It

This will be far from a comprehensive list, especially because worth is so uniquely tied to the individual making the choice. With that said, if you evaluate some of the factors below, there’s a good chance you’ll be able to have a clearer idea of whether or not surgery is worth it for you:

1. Your Other Options – If you’ve tried weeks of conservative treatments and have yet to experience any meaningful recovery, the prospect of surgery may seem more lucrative. However, if your doctor believes that one or more conservative care techniques could help you find relief without surgery, then you may want to hold off on an operation. Surgery will appear more tempting if you’re running out of effective treatment options.

2. Your Individual Goals – Really consider what you hope to get out of surgery. Do you want to return to certain physical activities, or do you simply want to walk without pain? Figure out what’s important to you and talk with your doctor to see if surgery could realistically help you reach your individual goals.

3. Your Health – Your overall health can help to determine whether or not it is worth it to pursue surgical treatment. If you have a number of underlying health conditions or you are an elderly patient, the risks associated with surgery may not outweigh the benefits of the operation. Have a conversation with your foot and ankle specialist about your health and understand your individual risk profile.

4. The Financial Impact – Nobody should shy away from necessary medical care as a result of the impending financial implications, but the fact of the matter is that it is smart to at least get a general sense of how the operation could impact you and your family financially. Talk with your doctor, get surgical codes and connect with your insurance provider to learn about your coverage and what type of medical expenses you can expect when all is said and done.

5. Your Commitment To Recovery – Surgery is only a small part of your recovery journey after a foot or ankle injury. You’re going to have to put in the work during physical therapy in order to make the strongest recovery possible. If you hope to just lay in bed and make a full recovery, that won’t happen, and for these patients surgery may not be worth it. If you’re willing to put in the work on your end to make the strongest recovery possible, it’s much more likely that surgery will be worth it for you.

6. Your Care Team – Finally, surgery is more likely to be worth it if you put your faith in the hands of an experienced surgeon. You need to move forward with a surgeon you have complete faith in who has a track record of success, because that will help increase the likelihood that all your efforts will be worth it. Don’t commit to surgery until you find a surgeon that you have confidence in.

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Recovering With Screens

If you want to pass the time without staring at a screen after foot or ankle surgery, keep these activities in mind:

1. Grab A Book – Head to the library before surgery to grab a few books that you’ve had your eye on for a while.

2. Puzzles – Set up a table and dive into a 500- or 1,000-piece puzzle to pass the time during your recovery.

3. Crosswords – You can also buy a book of crossword puzzles or Sudoku puzzles to keep your brain engaged while you recover.

4. Call A Friend – Pick up your phone and give a friend or family member that you haven’t spoken with in a while a call to catch up.

5. Write A Letter – Write a letter to friends or family. Everyone likes getting hand-written letters from loved ones, so pass the time by writing an “old school” letter to someone.

6. Start A New Hobby – Have you ever wanted to learn to play the guitar or cross-stitch? Now’s the time.

7. Continuing Ed – Don’t fall behind on your schoolwork if you have to miss class after surgery, or use this time to pick up continuing education credits if you have a licenses that requires you to pursue CE credits at regular intervals.

8. Make Lists – You can also pass the time by making lists. You can start listing birthday or holiday gift ideas for loved ones so that you’re ready when the time comes, or you can just challenge yourself to see how long of a list you can create. How many fruits can you name? How many animals that start with the letter “C” can you name? Have some fun making lists.

9. Read Up On Your Rehab – Odds are you have some reading materials from your care team that you can read during your recovery. Learn more about your operation and recovery so there are no surprises and you’ll be armed with the knowledge of how you can help your rehabilitation along.

10. Board Games – Gather the family around your recovery area and play some board games! Play a new game each night and see who is the overall champion by the week’s end!

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Improving Your Likelihood Of Surgery Success

Believe it or not, you actually play a significant role in the success of your surgical operation. Your surgeon may provide the technical skill to complete the operation, but your commitment to your pre- and post-op care will go a long way in determining your functional recovery. Here’s a look at some of the things you can do to improve your odds of a successful foot and ankle surgery.

Prehab – You don’t have to wait until surgery is complete to start rehabbing your foot or ankle. While you’re waiting for surgery, do some gentle strength training exercises or a physical therapy routine. The stronger your foot is prior to surgery, the stronger it will be after your operation. Doing some exercises beforehand also helps you get used to performing strength training exercises regularly, which you’ll likely be doing after your operation.

Work On Your Weight – We understand that it may not be easy to try and lose some weight ahead of surgery, especially if your foot or ankle surgery makes movement difficult, but it’s really important that you work towards a healthy weight. Being overweight or obese increases your likelihood of a problem during surgery, and even though your doctor will do everything in their power to control these risks, surgery doesn’t go perfectly every single time. Strive to improve your odds of a successful surgery by working towards a healthy weight.

Follow Your Doctor’s Advice – This is a rather simple tip that many people oftentimes overlook. Your surgeon will give you some pre-op and post-op advice, and it’s imperative that you follow their instructions. They may tell you how to adjust your diet or your medication schedule prior to or after your procedure, or they may explain how to get the most out of your physical therapy program after surgery. Pay attention to what they are saying and heed their advice to keep your surgery and recovery on track.

Mind Your Restrictions – Similarly, keep your restrictions in mind during your recovery period. One of the most common reasons for a failed surgery or a setback during recovery is because the patient steps outside their restrictions. Don’t head back to work or start driving on your surgically-repaired foot until you have been given clearance by your physician. Your restrictions have been put in place for a reason, so respect them. If you have questions or believe your restrictions are outdated, have a conversation with your surgeon.

Take PT Seriously – Physical therapy will likely be the single most important aspect of your post-op recovery plan in terms of helping you restore as much physical function as possible. Don’t skip your exercises or simply go through the motions. Really push yourself to become stronger and more flexible so that your foot can handle the stress you’ll throw at it once you’re fully recovered. If you don’t take PT seriously, you may never make a full recovery.

Improve Your Diet – Finally, if you work to improve your diet before and after surgery, you’ll be helping your body get nutrients it needs that aid in the recovery process. Eat a healthy diet full of fruits, vegetables, fatty fish and whole grains, and your body will have access to nutrients that can help with tissue repair and inflammation control. A healthy diet can also help you manage your weight before and after surgery.

Circle back to our blog to keep tabs on our surgery series, and check out our first installment on what you should know before your surgical procedure.

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Can I Avoid Foot Surgery?

Again, there’s no guarantee that you’ll be able to avoid surgery even if you follow all of the below tips, because the fact of the matter is some injuries simply need surgery in order to heal correctly. That said, if you keep these tips in mind, you may be reducing your likelihood of needing surgery or suffering an injury that could require an operation.

1. Wear The Right Shoes – So many foot injuries and conditions come down to wearing the right shoe for the job. If you’re performing athletic activities and you’re not wearing the proper shoe or cleat, you’re at a higher risk for ankle sprains and fractures. If you’re regularly wearing high heels instead of comfortable and supportive shoes, you’re at risk for bunions, arch problems and hammer toes. If you’re not wearing protective shoes on the job site, you’re at risk for puncture wounds or slip and fall accidents. Think ahead for what’s to come and plan your footwear based on the activities you’ll be performing so that your shoes don’t greatly increase your risk of an issue that requires surgery.

2. Early Intervention – Another helpful way to prevent surgery is to treat a small problem before it snowballs into a major issue. If you notice a mild bunion forming or some pain on the underside of your heel with the first few steps in the morning, set up a consultation with a foot specialist. If you keep doing the same actions that led you to this position in the first place, not only will symptoms fail to improve, odds are they will worsen. Putting off treatment too long may mean that surgery is the only reasonable option. Stop small foot and ankle issues before they turn into an issue that requires surgery.

3. Aggressive Rehab – If you have suffered an injury, you may be able to avoid surgery by aggressively jumping into a rehab program. Some ligament tears and tendon issues can respond to careful activity modification followed by weeks of targeted physical therapy, but only if you’re willing to put in the work. If you just hope that healing will runs its course while you stay in bed, you may not experience enough healing or you may leave yourself susceptible to future injury, which could result in surgery. Oftentimes surgeons work to avoid an operation if they can, and that typically means pursuing an active conservative care program.

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We’re also in a phase of the pandemic where we can test patients upon their arrival to the emergency room or surgery center for COVID-19 and have the results in an hour or less so that providers can take the right precautions in the event the patient is positive for COVID. Because of the availability of rapid testing, researchers are now able to gather more research on surgeries performed on COVID-positive patients and compare their outcomes to the general public. Recently, they found that patients who tested positive for COVID were more likely to have worse outcomes following ankle fracture surgery than those who did not have COVID at the time of their ankle fracture operation.

In other words, you don’t want COVID if you need emergency surgery.

COVID And Ankle Fracture Surgery

For the study, researchers were able to track 9,835 patients who underwent ankle fracture surgery between April 1st, 2020 and June 15th, 2020. 57 patients were identified as COVID-positive at their time of their ankle fracture repair operation. Those 57 patients were matched to 57 control patients of similar demographics and variables, and the results of surgeries were tracked.

After looking at the data, researchers found that patients who were COVID-positive were more likely to experience:

• A minor adverse event (3.1 times more likely)
• A serious adverse event (5.48 times more likely)
• Any adverse event (3.89 times more likely)

The study stopped short of explaining exactly why COVID-positive patients were more likely to suffer adverse events, but that’s due in part to the fact that we’re still learning about this virus each and every day. We know that COVID has a significant impact on many bodily systems, so it should not come as a surprise that your surgical outcomes tend to be worse if your body is simultaneously trying to fight off the virus and recover from the physical trauma of surgery.

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Foot Surgery And Vitamin Intake

A recent study decided to take a look at the onset of a condition known as complex regional pain syndrome after a foot or ankle procedure. While the specific cause of CRPS is unique to the individual, it’s typically caused by damage to peripheral sensory neurons that relay pain signals to the brain. Misfiring neurons can make the brain believe its in pain when there shouldn’t be a pain response.

Vitamin C has been reported to be helpful in preventing CRPS in the wake of elective surgery. Study authors decided to test that hypothesis in regards to foot and ankle surgery. For the study, researchers conducted a randomized study involving 329 patients undergoing foot or ankle surgery. One group took vitamin C supplements after ankle surgery, while the control group did not.

After looking at the data, vitamin C was statistically linked with a decreased risk of CRPS compared to those in the control group. Conversely, alcoholism and cast immobilization were associated with an increased risk of CRPS. Researchers concluded that taking one gram per day of vitamin C during the 40 days following foot or ankle surgery helped to reduce the risk of CRPS onset.

The findings are not earth shattering, but they do give even more credence to the idea that vitamin intake before and after a surgical operation can help reduce the risk of complications or post-op issues. We have been recommending a specific regimen of vitamins for patients to take both before and after surgery to help ensure their body can draw upon healthy nutrients, and this study just provides further proof that this regimen is helpful for our patients.

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When Should I Undergo Foot Surgery?

If your foot has been crushed by heavy machinery at work, it’s a clear sign that you need surgery. But what are other some more subtle signs that it’s time for foot surgery?

1. Weeks Of Failed Nonoperative Treatment – Most foot specialists will want you to try at least six weeks of conservative interventions before they even consider an operation. If you’ve tried a few different treatments and nothing seems to be working over the course of a number of weeks, it may be a sign that it’s time for surgery.

2. Between Seasons – One of the good things about an elective foot or ankle surgery is that you can be a little more flexible about when you choose to go under the knife. For many athletes, that’s during the offseason. If you’ve been plagued by repeated ankle sprains and ankle instability, and conservative care isn’t doing the trick, you may want to schedule your procedure for the end of the season. This will give you as much time as possible to recover and rehab before next season rolls around.

3. Doctor Recommends It – One of the more obvious indications that you could benefit from a foot operation is if your foot or ankle surgeon recommends it. Surgery is a big undertaking that a surgeon doesn’t take lightly, so if they believe you can recover without the operation, oftentimes that’s the route they’ll pursue. With that said, if they look at your foot and feel that surgery is your best bet, it’s likely in your best interest to schedule your operation.

4. Visible Deformity – If there is a visible deformity with your foot, even if it’s not painful, it’s an indication that you may need a minimally invasive surgery. There might not be pain now, but if there’s deformity, it’s likely only going to get worse if you keep doing the same things, and pain will eventually follow. For unsightly bunions or hammertoes, consider a minimally invasive surgery.

5. Severe Decrease In Quality Of Life – If your foot condition is significantly decreasing your quality of life, now is the time to talk to a specialist about your surgical options. You shouldn’t have to deal with daily foot pain or miss out on some of your favorite activities because of your foot issue, especially when a surgical procedure can help get you back on your feet. If you’re shying away from activities or dread taking that first step in the morning, consult with a foot surgeon.

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Treating Foot Injuries With Surgery

Here are five foot and ankle injuries that oftentimes achieve the best healing results when surgically addressed.

1. Bunions – The unsightly bump on the side of your big toe is called a bunion, and it’s caused by a misalignment with the big toe joint. Very small bunions can respond well to footwear changes, but for more moderate or severe cases, it’s unlikely the joint will shift back into a stable location without surgical intervention. Minimally invasive bunion correction is one of Dr. Silverman’s specialties.

2. Achilles Tendon Tears – The Achilles tendon is the strongest tendon in the body, but that doesn’t mean it’s immune from tears. It can heal fine on its own without surgery, but that takes longer and still leaves you at an elevated risk for another rupture. Surgically fixing an Achilles tear helps you recover faster and can make the tendon much stronger, allowing you to get back to sporting activities with a reduced risk of another tear.

3. Hammertoes – A hammertoe occurs when joints in the mid-toe flex upwards, giving your toes a scrunched appearance. Changing footwear can help take pressure off these toes, but oftentimes the damage to the soft tissues in the area is too severe. A small procedure can help to fix the tendons and muscles in the area causing your toe to flex upwards.

4. Ankle Instability – If you regularly roll your ankles, you may have loose or damaged lateral ankle ligaments. While it may not be painful in and of itself, it can put you at a higher risk for repeated ankle sprains and ankle fractures. Physical therapy can be helpful, but a minimally invasive corrective procedure can help to strengthen your ankle ligaments and prevent a potentially more serious injury down the road.

5. Morton’s Neuroma – Morton’s neuroma is a foot condition that affects the nerves in your toes near the balls of your feet. It often feels like you have a pebble or marble in your shoe under the ball of your toe. Oftentimes caused by wearing poor fitting shoes, this nerve issue can readily be treated with a minimally invasive outpatient surgery.

The post 5 Foot Problems That Are Often Fixed With Surgery appeared first on Lance Silverman, MD - Orthopedic Foot & Ankle Surgeon.

One of the biggest things we preach during the preoperative consultation stage is that patients need to have appropriate expectations for the upcoming procedure. We are very skilled at what we do and we’ll do everything in our power to help address your injuries, but know that we do not have a magic wand. Depending on your condition, there’s a chance that even if everything goes as planned during surgery, you’ll still have some lingering pain and discomfort after surgery.

A new study out of New York City found that mismatched expectations between patient and provider are not just an issue at our clinic. In fact, it happens in roughly 80 percent of cases. In today’s blog, we take a closer look at patient and provider presurgical expectations and explain how they can be better managed.

Presurgical Success Expectations

According to a study conducted by researchers at the Hospital for Special Surgery in New York City, patients tend to have higher expectations for their surgery than their physician. In fact, roughly two-thirds of patients undergoing a foot or ankle surgery had higher expectations for the operation than their surgeon. According to the data:

• 66.3% of patients had higher preoperative expectations than their surgeon.
• 21.3% of patients had expectations similar to those of their surgeon
• 12.4  of patients had lower expectations than their surgeon.

Another interesting finding during the study was that the majority of patients with lower presurgical functional scores also had higher postoperative expectations. The same correlation was found in patients with depression and anxiety, and in those with a high BMI. In other words, those with severe functional issues and those with physical or mental hurdles to recovery had higher expectations for their operation, whereas surgeons likely tempered expectations given the warning signs.

So why do patients often expect more from their foot surgery than what may be considered reasonable? Some believe that patients see surgery as a way to reverse physical damage, which isn’t always possible. Others believe the issue resides in the surgeon who fails to appropriately manage the expectations of their patient. That said, no provider wants to walk into a room and tell a patient that they may not be as healthy post-op as they had hoped.

“Although most surgeons do their best to engage in open conversations with their patients about what they can expect from surgery, many find it difficult to tell patients that they are not going be as good as new postoperatively,” said Scott Ellis, M.D., a foot and ankle orthopedic surgeon at HHS and author of the study. “It is challenging to get patients past the belief that surgeons have a magic wand.”

Dr. Ellis and his team believe the results of the study underscore the importance of an open and honest conversation about expectations prior to surgery, as well as the potential for preoperative education courses to ensure everyone is on the same page prior to surgery.

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