Common questions about surgery

Why do you advise elevation?

You should always elevate your leg after foot or ankle surgery. This is because gravity pulls fluid down so if you do not elevate after an operation, the leg will swell and this puts pressure on wounds (increasing the risk of dehiscence and infection) and is painful. Strict elevation is needed for the first two (and ideally up to six) weeks and thereafter, be sensible.


How quickly can I return to driving?

There is no defined criteria but before driving after foot or ankle surgery, you must decide if you feel safe to do so and confident of performing emergency braking without difficulty. Most patients return back to driving after eight weeks if they have not worn a plaster, or if they have had a plaster, then two to three weeks after this has been removed.

How high do I need to elevate?

The ideal level is to keep your operated area higher than the level of your heart since this is the ‘pump’ which keeps blood moving around your body. This is obviously not always practical but if you are in bed or resting on a sofa, this means propping your feet up on a few pillows.

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Do I get a lightweight plaster after surgery?

Some operations need a plaster cast to be applied to help protect the surgery whilst healing occurs. The first plaster applied in theatre is a ‘back slab.’ This is the traditional plaster which has an uncovered area typically over the front of the leg. This first plaster is usually heavy but is more flexible than the lightweight plaster so accommodates swelling much better. If you still need plaster after your 2 week wound check, this can be a lightweight fibre-glass plaster.

Commonly performed surgeries are explained below

Achilles tendon debridement with Haglund’s removal

This surgery involves an incision above your heel overlying the ‘pump bumps.’ The swellings within the tendon will be removed along with the bone bump (Haglund’s deformity) which is thought to cause it. You will be in a temporary plaster for two weeks during which time no weight is allowed on the leg. The blood supply to the skin in this area is not good so wounds are at an increased risk of infection and dehiscence. You must therefore strictly adhere to elevation and follow guidance on weight bearing. After two weeks, you will return to clinic for a wound inspection and application of a new plaster on which your full weight is allowed. Nonetheless, you should keep the leg elevated as much as you can tolerate and four weeks after surgery, your plaster will be exchanged for a medical walking boot. Driving can resume from four to eight weeks after surgery depending upon whether you have a manual or automatic car, and whether surgery was on the left or right leg. Wasting of the calf muscle is common due to immobility so you should work with a physiotherapist from week six to rehabilitate. Swelling is usually improving from four months and full recovery takes six to 12 months.

Ankle Arthroscopy

Recovery is dependent upon the reason why you are having surgery but in most cases, you should be allowed to bear weight fully with crutches immediately after surgery. During the first two weeks, you should keep the leg elevated as much as possible which reduces swelling. You should start circular, and up and down range of motion exercises which will reduce scar tissue formation internally. You will return for a wound inspection at two weeks, and then gradually increase activity levels. Swelling typically improves after three months and full recovery takes between six and twelve months.

Ligament stabilisation

Repair of the ligaments on the outer aspect of your ankle will require between 2 or 4 weeks in plaster. This depends upon the quality of your tissues and whether a synthetic augment is used. During this time, you will not be allowed  to bear weight on the operated leg, but can do so when out of the plaster and in an ankle brace. Physiotherapy should commence after removal of the plaster and whilst the brace is typically worn for six weeks, this is guided by how well you establish muscle control and stability. Patients typically report that they have returned to a good functional level by four months, although it can take up to twelve