Post Op Instructions and Protocols

Click here to jump to list of recovery protocols for each procedure

If you have a true emergency go to the ER at Hancock Regional Hospital – Page Dr. Adams.

For urgencies call our office at (317) 477-6683 – even after hours a nursing service will answer.

Weight bearing (WB) instructions following surgery are based on Dr. Adams protocols – please address this with him, or his Nurse Practitioner immediately if this is not clear to you.
If you are Non-WB or Heel-WB only, please ensure you have crutches, knee scooter, walker, etc… Please limit activities. You just had surgery. If you heal slowly, and stay excessively swollen, this is why.
Elevate as much as possible – Foot ABOVE level of the heart – this is rule #1
Do NOT change your dressings for any reason – if they become soiled/saturated with blood, water, etc call our office, and come in for change. NOTE: some blood on dressings is normal – however, if it starts to transfer to your furniture etc, please call.
Use ice packs behind your knee, and/or Cryo Cuff as instructed pre-operatively. Depending on your surgery type you may not use cryo cuff for 2 weeks after surgery. Do not ice continuously – take 1-2 hr breaks from it. For example, ice for 45 minutes – then take a break. Elevation is #1.
Take 400-600mg of Ibuprofen/Advil/Motrin every 4-6 hours after surgery (unless directed otherwise by your family doctor). This may be staggered from painkillers. For example, if you take hydrocodone at 1pm, take ibuprofen at 3pm, then painkiller again at 5pm, then ibuprofen at 7pm, and so forth.

Children/Parents should refer to pediatric dosing on box based on weight/age. Call us/pediatrician if unsure.
Bruised and discolored toes after surgery are normal – blood/fluid runs “downhill”.
Do NOT smoke, or drink alcohol during your recovery. Alcohol interacts with many medications including painkillers. Smoking will absolutely cause your incision to heal poorly – this has been proven in scientific literature.
Individuals that have cardiac conditions, kidney disease, diabetes, and venous or lymphatic vessel disease will swell for a considerable amount of time and often taken months to fit back into regular shoes.
Yes – discoloration of the foot/ankle/leg in the shower, or other environments where there is substantial temperature change is normal for months following surgery. This is due to swelling that is incompletely resolved.
If you have history of constipation from opiates/painkillers, consider taking Miralax or Colace starting the day after surgery. It is easier to prevent, than treat once constipation occurs.

Post Op Protocols

Note: Recoveries can differ from patient to patient based on multiple factors. The guidelines below are a general idea of what the average recovery will be.

Hindfoot/Midfoot Reconstructive Arthrodesis/Fusion Recovery
Download/Print PDF

Arthrodesis/Fusion Recovery

Procedures performed to correct Flat feet, Cavus feet, and Midfoot Arthritis

  • Weeks 1-2 in well padded posterior splint – NWB – elevate, ice behind knee, avoid activities except eating and using restroom
  • Weeks 2-6 in cast or CAM  boot – NWB – elevate, potentially use cryo-cuff – may become more mobile if tolerated using knee scooter and/or crutches
  • Weeks 6-8 — start weight bearing in walking boot as tolerated
  • Weeks 10 — start to transition back to shoe with possible lace-up ankle brace. Start physical therapy when applicable to regain strength and work on range of motion and limp elimination. 

NOTES: We will check vitamin D levels at time of surgery and optimize – 50-65 ideal range.

Control edema with compression socks and elevation

Use cryo cuff when ready to help provide comprehensive cold therapy

Use Vitamin E oil, Mederma etc to work on incision healing

Achilles Tendon/Haglunds Recovery
Download/Print PDF

Achilles Tendon Tear (not rupture)/Haglunds Recovery

  • Weeks 1-2 – NWB in posterior splint – ice behind knee, elevate, minimal activities except eating, using restroom 
  • Week 2 sutures come out (usually) – transition to walking boot – HOWEVER remain NWB for 1 more week
  • Weeks 3-6 – Very slowly transition to FWB in walking boot 
  • Weeks 6-10 – transition into sneaker – start physical therapy 

NOTES:

We will check vitamin D levels at time of surgery and optimize – 50-65 ideal range.

Control edema with compression socks and elevation

Use cryo cuff when ready to help provide comprehensive cold therapy

Use Vitamin E oil, Mederma etc to work on incision healing

Great Toe Joint Fusion/Arthrodesis
Download/Print PDF

Great Toe Joint Fusion/Arthrodesis

  • Weeks 1-2 (xrays taken) – NWB in posterior splint – ice behind knee, elevate, minimal activities except eating, using restroom 
  • Week 2 sutures come out (usually) – transition to walking boot – FWB as tolerated
  • Weeks 2-6 – FWB in boot as tolerated 
  • Weeks 6-8 (x-rays taken) — transition to sneaker as tolerated 

NOTES:

We will check vitamin D levels at time of surgery and optimize – 50-65 ideal range.

Control edema with compression socks and elevation

Use Vitamin E oil, Mederma etc to work on incision healing

Lateral Ankle Ligament, and Deltoid Repair and Scope
Download/Print PDF

Lateral Ankle Ligament, Deltoid Repair + Arthroscopic Joint debridement

  • Weeks 1-2 – NWB in posterior splint – ice behind knee, elevate, minimal activities except eating, using restroom 
  • Week 2-3 — remain NWB — sutures come out (usually) – transition to walking boot
  • Weeks 3-6 – FWB in boot as tolerated – use cryo cuff, elevate, compression socks 
  • Weeks 6-8  — transition to sneaker as tolerated with lace up brace and start physical therapy 

NOTES:

We will check vitamin D levels at time of surgery and optimize – 50-65 ideal range.

Control edema with compression socks and elevation

Use Vitamin E oil, Mederma etc to work on incision healing

Bunionectomy Recovery
Download/Print PDF

Bunionectomy/ 1st Metatarsal Osteotomy

  • 1st week post-op weight bearing in short walking boot – heel only
  • 2nd week post-op remove stitches, weight bearing as tolerated in short boot
  • 3rd-4th week full weight bearing in short boot – ice, compression socks, elevate
  • 5th-6th week – release back to sneaker if appropriate – manage swelling

NOTES:

Bunion surgery always causes significant swelling. The biggest hurdles in recovery are preventing stiffness at the joint, and managing swelling. The swelling may last up to 6 months.

Optimize vitamin D levels, use scar cream on incision, and range of motion activities are paramount for desirable results.

Ankle Replacement
Download/Print PDF

Total Ankle Replacement

  • 1st week – NWB in well padded splint. Take x-rays, evaluate incision. RICE therapy.
  • 2nd week – Same as 1st week
  • 3rd week – remove stitches if not already taken out at 2nd visit. Transition to weight bearing in tall walking boot once skin heals
  • 4th-6th weeks – FWB in tall walking boot. Range of motion exercises on own. Manage swelling.
  • 7th week – transition to sneaker with lace -up brace – start physical therapy if ready

NOTES:

The keys to success after joint replacement surgery is getting good incisional healing, and maintaining joint range of motion.

The incision site is closely monitored for any signs of infection

Patients are given Vancomycin (assuming no allergies) during surgery to help prevent Staph Epi infections

Achilles Tendon Rupture
Download/Print PDF

Achilles Tendon Rupture Repair

  • 1st week – NWB after surgery in posterior splint
  • 2nd week – Sutures removed if ready. Transition to boot with 2 wedges, partial weight bearing as tolerated.
  • 4th week – Start removing wedges from boot every other week. WB as tolerated in boot at all times. Compression sock. Light plantarflexion – pointing of toes against gentle resistance. DO NOT bring toes towards nose yet.
  • 8th week – Begin weaning out of boot to shoe with heel lift. Passive dorsiflexion only to neutral. Begin low resistance cycling.
  • 10th week – Start formal physical therapy
  • 12th week – Active dorsiflexion beyond neutral (90 degrees) allowed, eccentric strengthening exercises.
Tarsal Tunnel Release
Download/Print PDF

Tarsal Tunnel Neurolysis/Release

  • 1st week – WB as tolerated in surgical shoe – soft compressive dressing up to knee. Avoid excessive activities so as to prevent excessive tension on skin incision. Ice, elevate, NSAIDs, high dose Vitamin C (500mg twice a day)
  • 2nd week – Sutures may come out if ready. Continue RICE therapy, NSAIDs and Vitamin C. Continue in surgical shoe to prevent incisional irritation. Start silicone scar sheets.
  • 3rd week – Return back to sneaker. Continue RICE therapy, silicone sheets and vitamin C until 8 weeks.
Morton’s Neuroma
Download/Print PDF

Digital Neuroma Excision/Neurolysis

  • 1st week – WB as tolerated in surgical shoe – soft compressive dressing up to knee. Avoid excessive activities. Ice, elevate, NSAIDs, high dose Vitamin C (500mg twice a day)
  • 2nd week – Sutures may come out if ready. Continue RICE therapy, NSAIDs and Vitamin C. Continue in surgical shoe to prevent incisional irritation. Start silicone scar sheets.
  • 3rd week – Return back to sneaker. Continue RICE therapy, silicone sheets and vitamin C until 8 weeks.