Ankle Surgery Post-Operative Instructions

The following are post-operative instructions for patients who have undergone ankle surgery. Please refer to this reference sheet, which should probably answer most of the questions you might have. If you have further questions that need immediate answering, contact us at our office at 970 879-2663 or 855-969-2663.

CRUTCHES:
Following many ankle procedures, you will most likely be in a splint and will be asked to be non weight bearing for a short period of time. If you do not have a splint after surgery you most likely are allowed to do some weight bearing and this will be specified to you. Rarely I will let people walk immediately. Even if it states full weight bearing we prefer that you unload the leg walking on the heel or using crutches temporarily. We feel you will be more comfortable, with less pain and swelling, if you utilize the crutches for a few days to lessen or avoid the weight bearing impact to your foot. You may obtain crutches with a returnable deposit from City Market or Safeway, or borrow from a friend.

DRESSINGS:
You will have a bulky dressing over your ankle and probably a splint. Although it is very unlikely, you may notice some bloody spotting coming through the outer Ace wrap or cast. It is important for you to watch this area, and contact us if it continues to spread. Otherwise, any small area of spotting will dry and can be ignored until you remove the dressings.

SUTURES:
The sutures utilized in closing any wounds are usually an non absorbable type, and will need to be removed by Dr. Sarin or his nurse practitioner. They will usually be removed in 7-10 days unless the wound is not ready.

OFFICE FOLLOW-UP:
You will receive a call the day after your surgery, and the first post operative visit will be scheduled at that time unless instructed otherwise after surgery.

ICE:
Ice and elevation will help minimize the pain and swelling after surgery, especially during the first few days. Elevation, to be effective, involves keeping your foot and lower leg above the level of your heart. You can keep ice packs on the foot continually during the first few days without risk of frostbite injury to the underlying skin as long as the original dressings are in place. The initial post-operative wrap involves multiple layers of cotton gauze and padding, therefore insulating the skin surface reasonably well. Once we have removed the original dressing and applied only a light dressing we would recommend ice applications to the involved foot or ankle region for 20 minutes at a time, multiple times each day.

SHOWERS:
You will need to keep the dressing dry and a bath with the ankle kept out of the water works best. One trick is to use a large bag and at the very top of the bag use saran wrap, plenty of it, and be sure to go at least six inches above the bag. The bag should stop at your knee and the saran wrap would go to at least six inches above where the bag stops.

PHYSICAL THERAPY:
Depending on the type of surgery you underwent you may be provided a prescription for formal physical therapy at your first office visit or if you do have therapy before your first visit, we will fax it to your physical therapist. Please visit our Rehab and Physical Therapy page for access to a list of physical therapists in the Steamboat Springs Area.

Here are some exercises you can do immediately to help keep your leg strong. Isometric Quadriceps Setting: Hold your knee straight and tighten your thigh as much as possible. Hold for three to five seconds, and repeat several sets. You can do this frequently throughout the day, whether sitting, standing, or lying down.

Straight Leg Raising: While lying on your back, hold your knee straight with the opposite knee bent and tighten your thigh. Then lift your leg a few inches off the floor and hold for several seconds.

Range of motion: Unless instructed otherwise, we encourage you to increase motion of your knee as soon as possible, within your comfort range. Bend and straighten your knee while sitting, or lying down. Increase motion as tolerated.

MEDICATIONS:
You will be provided with a prescription for a pain medication when you are ready to leave the hospital. Usually we will prescribe Hydrocodone or Oxycodone. These are both generic names for two different narcotic pain relievers. If you are aware of a certain pain medication that you have previously had problems with, or one that you normally respond favorably to, please inform us so that we can give you the appropriate prescription. You may have the prescription prior to surgery to avoid filling it the day of surgery. You are welcome to use an over-the-counter anti-inflammatory such as Ibuprofen (Advil, Nuprin, etc.). These come in 200-mg tablets. The usual adult prescription dosage is 600-800 mg up to three times per day, usually taken with food. This would amount to taking 9-12 store tabs per day. The anti-inflammatory medicine can be taken on a regular basis along with the prescription pain medication, which is utilized on an as needed basis. You will find that the combination will lessen your need for the prescription pain pill. If you have a history of ulcers or of stomach irritation with aspirin or anti-inflammatory drugs, then you should avoid using an anti-inflammatory. Avoid taking any Tylenol with the hydrocodone or oxycodone. These two medications generally have Tylenol added in. If you’re not using hydrocodone or oxycodone you may use plain Tylenol alone. Plain tylenol is OK if you have no liver disease. Remember, the short acting pain pills often have acetaminophen (Tylenol) in them. The maximum daily dose of Tylenol if you have a normal liver is 3500-4000 mg. If you have a history of nausea with surgery we can prescribe a anti nausea medication (Phenergan). Try to take this medication regularly at first and prior to taking the narcotic pain pills to allow it to be most effective.

Please try to anticipate the need for any refills on your pain medication, and contact our office early in the day the day before running out completely. We strongly discourage calls for refills after business hours or on weekends.

COMPLICATIONS:
Most ankle surgery is a safe and performed as outpatient surgery, so postoperative complications are fortunately quite rare. The incidence of an infection deep within the joint is literally one out of thousands. Onset of symptoms would be approximately 5-7 days following surgery, and would consist of a significant increase in pain, swelling, warmth, and redness of the foot or ankle, fever, chills or night sweats. More common, but still quite rare, would be a small superficial infection or irritation at one of the skin incisions. There can also be a very small incidence of a blood clot developing deep within your leg veins. This would be characterized by a sudden onset of new pain (usually different from your surgical pain) or tightness in the back of your calf or knee. This usually begins about 5 days from the day of surgery. The presence or absence of a clot can usually be determined by a simple non-invasive ultrasound test at the hospital. Contact our office for any concerns at 970-879-2663 or 855-969-2663.