Bunion Correction

General Post-Operative Instructions for Bunion Correction

Anesthesia:

• You will feel a little off for a day or two after the anesthetic. During that time you should not drink alcoholic beverages, make any important decisions or engage in any potentially hazardous activities. It is very common to be slightly nauseated and you should start with a light, low fat diet until your appetite comes back. Don’t drink cold water, as it can upset your stomach.

Bathing and Wound Care:

• It is not unusual for some blood to show through on the splint. If bleeding seems to be continuing after the first 12 hours and the area is larger than 2 inches or so, please call the office.
• The splint should cover the wounds and support the leg but should not feel overly tight or uncomfortable. If it seems too tight you should call the office or go to the ER if it is after hours.
• DO NOT remove the splint until you have been seen in the office.

Pain Management:

• A long acting local anesthetic is injected into the ankle after surgery and usually wears off 6-12 hours later. As it wears off your foot will begin to hurt more.
• The interval for taking pain medication, as noted on the bottle, is a minimum interval. You should not take the medication more frequently than that. You may take the medication less often than on the prescription if you are not in pain.
• You have been prescribed a narcotic pain medication. This medication should be taken to relieve pain, not to prevent it. You should not set your alarm clock to remind you to take your pain medicine, nor should you take it on a set schedule even if you are not hurting, as this can result in overdosing of the medication.
• If you do not have trouble with ulcers or stomach pain, and if you do not have kidney problems, you may also take an anti-inflammatory medication in addition to or instead of the narcotic medicine. After the first day or two you may take an over the counter anti-inflammatory. An average sized adult may take three 200 mg ibuprofen (Advil/Motrin) tablets every 8 hours, or Aleve two tablets twice a day, with food for a period of two weeks.

Activity

• Elevation is the best way to decrease your pain and swelling. It only counts as elevation if your ankle is above your heart. Sitting in a chair with your foot on the coffee table is not enough. Please ice and elevate your leg for at least the first three days after surgery.

• DO NOT put weight on your foot. You may rest the foot on the ground if necessary.

• If your injured ankle is on the left and you have a car with an automatic transmission, you should be mechanically able to perform the functions associated with normal driving.
• If your right ankle is the injured one, you are not able to use your right leg to push on the brake or accelerator and are thus not mechanically able to perform the functions associated with normal driving.
• You should be mechanically able to do the things needed to drive. We cannot tell you what would happen if you did something that hurt and led to your losing concentration etc. You must make your own determination as to whether you are safe to drive.
• You cannot drive if you are taking narcotic pain medication.

• If you did not have your post op appointment arranged prior to surgery, you should call the office to arrange for an appoinment that works for you. You need to be seen in 2 weeks.
• At that time your splint will be removed and your incisions inspected. All stitches will be removed. A special wrap is applied to your big toe to help keep it straight and then a cast or boot will be applied. You may not put weight on this unless otherwise instructed for 4 more weeks.
• You weekly to replace the special wrap holding your big toe straight.
• At the six week follow-up visit, your cast will be removed and new x-ray films taken. If the fusion looks good, a removable cast boot will be applied. This is to be removed 5-6 times a day for range of motion to your ankle and/or foot. You will begin to put weight on your foot in a gradual fashion with the boot on. This begins by continuing to use the crutches or walker while placing about 25% of your body weight on your foot. When that becomes comfortable, increase the percentage of weight on the foot. Do this in a gradual fashion, so that by the time you return for the next follow-up in six weeks, you will be fully weightbearing on the foot with the boot but without crutches.
• During this time walking in a swimming pool is excellent therapy. Do this in chest deep water without the boot.
• At the three month follow-up visit, new x-ray films will be taken. If the fusion appears solid, you may begin to transition into shoewear at your own pace.
• Please remember you had a significant operation to your foot/ankle – swelling is normal and expected for the first six to nine months.
• Ankle and foot surgery takes time to recover from. Most patients will find that improvement takes six to nine months to occur and can continue for up to 18 months.

• Fever greater than 101.5 (it is very common to have a low grade fever the first night or two after surgery)
• Redness or swelling that is spreading from the edges of the incisions
• Pain that is out of control or worsening and not relieved by rest, elevation, ice and pain medication.
• Chest pain, shortness of breath