Foot & Ankle/Podiatry Resources & FAQs

The decision to have foot or ankle surgery is a complex one. Recovering from foot or ankle surgery could require that no weight be put on it for six to eight weeks, followed by a short period of time in a walking cast. This significantly impacts a normal lifestyle, and it may take many months to fully recover. However, surgery does provide pain relief and return to function. It's useful for treating conditions that have not responded to nonsurgical methods, especially when there is bone, joint, ligament, or tendon damage.

The foot is the first structure to hit the ground bearing weight. It has to disperse greater force than any other joint in the body. After an injury or surgery, it can take a long time for the foot and ankle to be able to handle normal weight loads without pain or further damage.

Foot and ankle surgery works very well when the correct procedures are chosen for specific problems. The greater the focus on pain relief as the primary reason for surgical intervention, the higher chance of success is.

No surgical procedure is without potential complications. But most complications are minor and don’t affect the outcome. These can include swelling, numbness, excessive scar tissue, superficial infections and acute pain. Some complications can affect the outcome of surgery. These include continued pain, worsened pain, recurrence of the problem or deformity, delayed or nonunion of bone correction and hardware failure.

The three most potentially serious complications following surgery are osteomyelitis (bone infection), deep vein thrombosis or blood clot and complex regional pain syndrome. Virginia Mason Franciscan Health has standard procedures in place to quickly recognize and treat these complications when they arise so long-term complications can be minimized.

Generally, foot and ankle surgery is not tremendously painful provided you follow postoperative instructions. A numbing medicine is placed around your ankle after surgery. You may not have any pain for four to 24 hours after surgery. The more your foot is elevated above heart level after surgery, the better you'll feel. We give painkilling medications after surgery, but most people do not need to use these medications longer than a week.

For most procedures, your surgical site cannot get wet until the stitches are removed. This is usually done 10 to 14 days after surgery. You'll be given a special bag to keep the surgical area protected while showering or bathing. If there is external hardware, you cannot get your foot wet until the hardware is removed, usually about six weeks after the procedure. After the stitches or hardware are removed, we require that you avoid soaking your foot in a bathtub, hot tub or swimming pool for an additional two weeks.

It depends. Some procedures only require a protective shoe postoperatively. Others require a postoperative cast for one to two weeks, followed by a removable walking cast or boot. The walking cast is then worn for protection during the remaining period of not putting weight on the leg and as protection to transition from this stage to weight-bearing.

You need someone to bring you to your surgery and take you home. You should avoid driving for the first week after surgery no matter what was done. After that, driving depends on your transmission and which foot was operated on. If you have a manual transmission, you can’t drive during the entire non-weight-bearing period. If you have an automatic transmission, you may drive if your surgery was on your left side. If your surgery was on your right side, you shouldn’t drive during the entire non-weight-bearing period, which may be six to eight weeks. If you absolutely must drive after foot surgery, there are left-foot accelerators that can be installed.

If your job can accommodate non-weight-bearing use of your leg, then you can usually return to work three to five days after surgery, depending on your pain. If your job will not accommodate non-weight-bearing use of your leg, you'll have to be off work during this recovery period and need to have modified duties when you return until you're out of your protective boot.

Physical therapy (PT) is patient- and procedure-specific. Usually, PT is necessary for major reconstructive procedures and in situations where transient complications such as excessive scar tissue or stiff joints occur.

Anesthesia is based on the length of procedure, type of tourniquet used and your anesthesia wishes. The options include local anesthesia, regional blocks (popliteal/spinal) or general anesthesia. All local and regional anesthesia is accompanied by conscious sedation so that you're unaware of the procedure. Our primary goal is to provide you the safest, pain-free anesthesia.

A tourniquet is a cuff that is placed around your ankle or thigh during surgery to stop the blood flow to your leg. This allows us to be more efficient. A tourniquet is safe for up to two hours and can be deflated and reinflated for longer cases.

Unless your surgery is done on an emergent basis, or there is a significant complication, you won’t be admitted to the hospital. Most surgeries are done on an outpatient basis, and you can go home the same day as your surgery.

Most foot and ankle surgery is considered elective. However, if it's being done to reduce pain and dysfunction, most insurance plans have good coverage for elective foot and ankle surgery. It's impossible to know the details of each individual plan, so it's up to you to determine whether your insurance will pay for surgery. Virginia Mason Franciscan Health can supply procedure codes for your insurance company, and you can contact our billing department to find out how much we charge for certain procedures. In addition to your surgeon's fees, there are anesthesia charges and facility fees that come with using the operating room.

Your surgeon will give you contact information and be available to answer questions after surgery. Some surgeons work with residents or fellows, and if they are involved with your case, you'll also be able to contact them after surgery.

Steroids are hormones produced by the body that have many metabolic functions. The steroids Virginia Mason Franciscan Health podiatrists use for controlling inflammation are called corticosteroids. They are produced by the cortex of the adrenal glands above your kidneys. Therapeutic steroids are synthetic analogs of the body's naturally occurring corticosteroids—cortisone and hydrocortisone—and come in injectable and oral forms.

Corticosteroids have many metabolic functions, the most potent and primary function being their anti-inflammatory properties.

When cells are injured, they release products called phospholipids. Enzymes called phospholipases convert phospholipids to arachidonic acid. Arachidonic acid (AA) is the chemical mediator of inflammation in the body. AA goes through several different chemical reactions (called oxygenation) to produce several chemical mediators of inflammation (leukotrienes, prostaglandins and thromboxane). These chemicals have many effects, which include blood platelet aggregation, increased cell permeability (swelling), further recruitment of inflammatory chemicals (histamine, serotonin, bradykinin), and recruitment of cells called macrophages (these cells remove damaged tissue, but their byproduct is scar tissue).

Corticosteroids are phospholipase inhibitors that prevent phospholipids from converting to AA, thus stopping inflammation at the beginning of the process. Corticosteroids have what is called a catabolic or "breakdown" effect, which is how they decrease scar tissue. The mechanism of this effect is unknown.

Corticosteroids are very safe and effective in low doses. Side effects occur in less than 1 percent of people and usually involve facial flushing, insomnia, increased irritability, and increased pain.

Steroid injections are more effective because the potent anti-inflammatory is administered directly into the painful area. Absorption is very slow, so side effects are rare. The injections, however, are fairly painful. The oral form of steroids are not painful, but they have more side effects and do not work directly on the painful area.

Although it's known that too much cortisone is harmful, an absolute maximum number of injections has never been established. As long as the injections are providing a therapeutic benefit, a series of up to six injections is well tolerated (most people only need one to two injections).

Nonsteroidal anti-inflammatory drugs, such as aspirin, ibuprofen and naproxen are safe and effective, but only work on certain portions of the inflamed area. They do not have any effect on scar tissue. Tylenol is not an anti-inflammatory.

An orthotic is an insert, either soft or firm, that replaces the insole of your regular shoe. It's classified as either custom or over-the-counter (OTC). Custom orthotics should only be made by a podiatrist or physical therapist who has experience treating foot and ankle disorders. The best OTC orthotics are available at running stores or specialty shoe stores. It's recommended no more than $60 be spent on an OTC orthotic because the money might be better used toward having a custom-fit orthotic made.

Hundreds of scientific studies have been performed that demonstrate orthotics perform three major functions:

• First, orthotics help disperse forces across your foot so one specific area is not getting overloaded.
• Second, orthotics help slow down pathologic motion, such as overpronation (too much inward roll) or oversupination (not enough inward roll).
• Third, orthotics improve what is called proprioception, which is your foot's awareness of its position in relation to the ground. This is a subconscious, neurological pathway, and one reason orthotics usually feel good when you put them in your shoes.

Although over-the-counter orthotics work, custom orthotics work better and are more comfortable. We recommend them when over-the-counter orthotics fail to relieve symptoms. Custom orthotics are made of higher-grade materials that last longer and are more expensive. When a custom orthotic is necessary, it's crucial that a podiatrist is involved, as the wrong type of orthotic can actually make a condition worse or even cause a different problem.

This depends on the type of activity. The more running one does, the quicker the orthotic will wear out. Over-the-counter orthotics typically last about one year. Custom orthotics usually last three to five years—sometimes longer. With children, we usually replace orthotics every one to two shoe sizes, depending on comfort.

We recommend you contact your insurance company to find out what your plan will pay for. Virginia Mason Franciscan Health accepts many health insurance plans.