It is important that you understand what having surgery involves, what  your recovery may be like and the potential problems or complications that may  occur after surgery. 

What to Expect 

The foot and ankle is a very complicated structure and consists of 28 bones, 35  joints and over 100 muscles, tendons, ligaments and nerves that make it all work. As a result, if surgery is required, it may be very complicated in nature and have a  lengthy recovery period. 

What are the Benefits of Surgery? 

Surgery is performed on the Foot and Ankle for a number of reasons, including: • To reduce or relieve pain 

• To correct deformity 

• To remove excess bone or soft tissue swellings 

• To increase Mobility 

• To facilitate healing (in the case of broken bones or soft tissue injuries) 

Returning to normal activities 

Realistically it will be several months before you are back to normal activity. Swelling  of your lower limb is normal and it can take up to a year for this to subside. Your  healthcare provider will advise you when you can resume driving and return to work.  

If you have been wearing a cast, following removal, you may be asked to walk in a  special removable boot for a further few weeks, increasing your walking and activity  as your foot allows. 

Most people make a good recovery following foot and ankle surgery. Although, in  certain operations, you may have lost the ability to move certain joints, your pain will  be much reduced. Other joints around the foot will have to work harder so they may  ache for a little while whilst they are adjusting, and you may also have a small limp. 

You may require physiotherapy following your surgery to increase the range of  motion in your foot/ankle. Your healthcare provider will advise you if physiotherapy  is required.  

Is there anything I can do to increase the success of my  Operation? 

Smoking seriously affects bone healing cells so that the wound AND BONES are  less likely to heal; it also increases your chance of post anaesthetic chest infection  and you are strongly advised to give up or at least cut down drastically to help  reduce this.  

If you are overweight, this has implications for your anaesthetic and puts excessive  loading on your feet. Losing weight has many benefits for your planned surgery and  your health in general.If you need advice about smoking cessation or weight loss,  your healthcare professional can provide information to assist you.

Are there any alternatives to Surgery? 

If pain is the issue then that can be controlled with adequate regular painkillers,  relieving pressure over deformities may also help. Most patients will have already  tried simple painkillers such as Paracetamol and simple anti-inflammatories such as  Ibuprofen, There is some evidence to suggest that glucosamine, and fish oils may  help relieve your symptoms and these should be discussed with your own doctor  before you take them. It is worth noting that any supplements you take are usually  stopped prior to an anaesthetic given for surgery. Deformities may lead to severe  pressure and friction inside your footwear; this may lead to ulceration and infection  which then becomes difficult to treat.  

Wider fitting shoes are the obvious solution to accommodate deformities. Custom  made shoes and/or insoles may be an option, these measures will avoid the potential  risks and complications of an operation. If these measures help to reduce your  symptoms then you may not require an operation at all. Your surgeon may decide  to send you to an Orthotist who specialises in footwear and insoles to try and help  relieve your symptoms and aid your walking. 

Some devices such as toe spreaders, spacers, shields, insoles and corn protectors are  readily available commercially. The use of a walking stick and stout ankle boots may  help support your feet and ankles, insoles may also help. Exercise, as painful as this  might be, is good to keep your muscles and bones strong and help reduce stiffness  within the joint(s). 

Your doctor may consider putting a steroid injection into an affected joint to try and  reduce painful symptoms for a while. There may be side effects from doing this and  cannot be repeated too often. 

There are many operations that can be carried out on your foot/ankle to correct it;  these will have been discussed with you prior to your admission, and may include  the following: 

• Removing excess bone, metalwork or soft tissue. 

• Realigning bones. 

• Releasing/tightening ligaments/tendons. 

• Straightening one or more of your lesser toes. 

• Stiffening or replacing a joint. 

The length of the operation depends on the severity of your condition and how it is  to be corrected, if you require surgery to multiple bones, joints or soft tissues, then  this will lengthen the time of your operation.

Recovery from your Operation 

Some operations are carried out as a day case allowing you to go home the same  day. However, more complex surgery will require you to stay in hospital. Once  the healthcare team are happy that you are fully recovered, circulation to your  feet is good, you are safe and can use the walking aids provided then you will be  discharged from hospital. If you are kept in, it will be for sound clinical reasons. 

If your Healthcare Professional says you will need walking aids, the hospital will  provide them and a physiotherapist will teach you how to use them safely. If you  have been instructed not to weight bear through your operated foot, you will be  required to hop. If you are unable to hop using walking aids such as crutches or a  walking frame, you may require a wheelchair. Your local Red Cross or mobility shop  can advise on a short term loan solution – for more information please see our Foot  and Ankle FAQs on the Orthopaedic Therapy Team webpage.  

Before coming into hospital, think about what you will need at home - perhaps  do some extra shopping before your surgery, or ask someone to do it for you. If  needed, perhaps do some cooking in advance, and maybe clear some areas of your  house of things that may trip you up or get in your way. If you manage to loan a  wheelchair, make sure you trial it at home to check for space and doorway size.  Think about bringing a bed downstairs if hopping is going to be difficult.  

If a need for help at home is identified, a referral to the Occupational Therapist can  be made.  

For further information on how to prepare for home after your operation, please  visit the Orthopaedic Therapy Team webpage and view our Foot and Ankle FAQs.  

Depending on what operation you have, you will be discharged in either thick wool  and crepe bandages on your feet and will be provided with rigid, wooden soled  sandals or you will be discharged in a plaster cast.

What are the Risks of Surgery? 

All surgery carries potential risks. Whilst healthcare professionals aim to make your  operation as safe as possible, there will be some patients who have complications.  Any serious risks will be fully discussed with you as some could be fatal and our aim  is to ensure you are fully aware of all and even unlikely risks as part of the informed  consent process.  

Anaesthetic Risk 

You will see an anaesthetist on the morning of surgery and discuss the best type of  anaesthetic for you and the risks associated with it. There are various anaesthetics  that can be used nowadays and these will be discussed with you to find the most  suitable one for you. 

General Risks and complications of surgery 

Pain varies a lot in different patients. You will be given pain relieving medication to take home with you and the best advice is to elevate your leg as much as possible to reduce swelling and to take your medication as prescribed without missing any doses.  

Bleeding; this may be noticeable through your dressing or plaster but is rarely a  cause for concern. However, if you are at all concerned, you can contact the helpline  detailed below. 

Swelling; Your foot and ankle will swell after surgery. This is entirely normal and  may persist, depending on the type of surgery for several months. The best advice is  to elevate your leg/ legs whilst resting. 

Nerve damage; damage to nerves around the operating site is extremely rare but  may lead to numbness or permanent pain if it gets caught up in scar tissue. Nerves  may also be unintentionally damaged by pain relieving anaesthetic blocks. 

Blood clots; these may form in your lower leg (Deep vein thrombosis -DVT) or may travel to your lungs causing a Pulmonary embolus (-PE). (Risk; 1 in 1,000), If you are at risk you will normally be prescribed an anti-clotting agent to help protect you from this. If you develop pain, swelling or redness in your leg or the surface veins appear larger than usual you may have a DVT and should seek advice straightaway. If you feel pain in your chest or back and become breathless, you may have a clot in your lungs and should call for an ambulance urgently or go straight to an Accident/Emergency unit informing them of your symptoms and that you have had recent surgery.  

Infection; if you get an infection it usually affects the skin only (Risk 1 in 50) and may require regular dressing changes and antibiotics. Deep infection is rarer but  more concerning and may require further intervention. 

Non-union/Mal-union; in a small number of patients the bones may be slow to heal  (Delayed Union) or do not heal at all (Non-union) or can heal at an incorrect angle  (Mal-union), (Risk 1 in 50). A second operation may be required to put things right. 

Loss of movement in the foot or ankle; if your operation involves fusing a joint  due to arthritis then you will have loss of movement in that joint, this is normal. 

Stiffness; for soft tissue or joint surgery, stiffness may be due to scarring or  prolonged swelling; (Risk; 1 in 25) this usually settles in time. Physiotherapy may be  required to assist with this.  

Severe pain, stiffness and loss of use of the foot and ankle; (complex regional  pain syndrome). The cause of this is unknown. If it happens, you will need further  treatment involving physiotherapy and painkillers. 

Recurrence of deformity; in some types of surgery, there is a chance your  condition may recur. There are a number of reasons why this could happen. This  will be discussed with you by your Healthcare Professional. If it does then you may  require a further operation to correct this.