Post Op Instructions and Protocols

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 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

• 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, 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/ 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.

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 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 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.

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.