Post Surgery

The First Two Weeks

For the first two weeks after returning home, it is important to rest. Help with completing daily tasks may be needed.

Many patients find that simply completing basic care takes up a lot of energy – this is normal, and will improve with time. Having friends and family as support is always very helpful. Below are some suggestions to help speed up the healing process:

Rest when needed,
Eat healthy food,
Diligently complete the exercises provided by physiotherapy or the surgeon,
Follow all instructions provided about how much weight-bearing is allowed,
Do not remove the dressing, cast, brace or boot,
Do not get the effected area wet,
Attend all follow up visits with the doctor and physiotherapist so that close monitoring can take place.

Pain

Continue to monitor your pain. The pain from surgery should slowly get better over the first 6 weeks after your surgery. Take your pain medicine regularly. Plan to take your pain medication an hour or so before you do activities or exercises that might cause you pain.

Talk to your doctor or physiotherapist if your pain is making it hard for you to rest or is affecting your mood.

Many people find that doing things like deep breathing or keeping distracted can help lower their pain level.

Deep Breathing

When you focus on deep breathing, you help relax both your mind and body.

Find a quiet place and sit comfortably.
Slowly and deeply breathe in for 3 seconds.
Hold your breath for 2 seconds.
Slowly breathe out for 3 seconds.

Distraction

This is when you do activities that interest you. Doing an activity can distract you or keep your mind off your pain. For example: reading books, watching TV, listening to music, playing cards.

Pain Medicine

Your surgeon will give you medication to help your pain while in the hospital and when you go home. You might hear pain medications called ‘analgesics’, or opioid and non-opioid medications. The usual types of pain relievers used after surgery are non-opioid pain relievers and opioid pain relievers.

Non-Opioid Pain Relievers (without narcotics)

For small to medium pain (pain rating scale of 3 or less).
They do not have opioids in them.
Most common non-opioid pain medication used after ankle surgery is acetaminophen (Tylenol). Take no more than a total of 3,200 mg in a day.

Opioid Pain Relievers (narcotics)

For medium to extra large pain (pain rating scale of 4 to 10).
Includes morphine, hydromorphone, oxycodone, codeine, and fentanyl.
Even though these are ‘narcotics’, do not worry about becoming addicted to any of these medicines. People only become addicted if they take opioid medications for reasons other than to control pain.

Quick Tips for Taking Opioids

Opioids can lower your blood pressure. You might feel dizzy when you move around or change position. Take your time when moving from lying to sitting, or sitting to standing.
Opioids can make you sleepy. This should go away within a few days of starting your pain medication.
Opioids can make you constipated (see the section on Constipation).
Opioids can give you an upset stomach. Take your pills with a full cup of water and at a time when you are eating, or just after eating. If you are still feeling sick to your stomach take an over-the-counter medicine for nausea (such as Gravol) as directed.
If you are given long-acting opioid tablets, swallow them whole. Do not crush or chew them. Crushing or chewing causes the drug to release immediately and could result in overdose or other unexpected side effects. It also causes the medicine to work for a shorter time.
Take the medicine the way your surgeon told you to. Do not take more than the maximum dose on the label.
Use the pain rating scale to assess your pain level every four hours. Don’t wait until your pain gets really bad before taking medicine or using other ways to ease the pain.

Take the medicine the way your surgeon told you to. Do not take more than the maximum dose on the label.

Use the pain rating scale to assess your pain level every four hours. Don’t wait until your pain gets really bad before taking medicine or using other ways to ease the pain.

Ice

Ice helps reduce pain and swelling. However, do not put the ice directly on top of the wound until it is completely healed (at least 14 days).

Place ice in a clean plastic bag. (You can use a small bag of frozen peas instead. You must label the bag ‘Do Not Eat’. You can refreeze the peas. You must throw the peas away when you no longer need to use them for ice.)
Put a single layer of towel between the ice bag and your skin.
Check your skin under the ice. It should be a little bit pink. It should not be red or white. If it gets too cold, it is possible to cause an ‘ice burn’ of the skin.
Leave the ice in place for no more than 10 minutes each time you use it.

After the first few weeks, ice is not very good at reducing swelling. Use ice to reduce inflammation and swelling only if your skin is hot to touch and red. When your foot or ankle is hot and red, use ice for 10 minutes every hour while you are awake.

Ice can be used to reduce your pain at any point in your recovery (whether during the first few weeks or even several weeks later) but only for a few minutes (about 5 to 10 minutes) each time you use it.

Swelling

For the first few days after you leave the hospital, continue to keep your leg elevated most of the day. Find a way to rest so that your foot is always 15 cm (6 inches) higher than your heart.

Over the next two weeks, elevate your foot often. The amount of swelling will be different for each person and also depends on the kind of surgery you had.

If you have had minor surgery and have less swelling, you will not need to elevate your foot as much.
If you have had major surgery and have more swelling, it is very important to keep your foot elevated most of the time.

Caring for the Surgical Area

It is important to take good care of the surgical area so that it heals and does not get infected.

Clean your wound as directed.
Keep your dressing and wound dry. We let you know when you can wash your foot and wound in the shower.
Do not put any cream or lotion on the wound.

Sutures

The sutures or stitches hold the wound together. They are taken out in your surgeon’s office. This is usually done 10 to 14 days after your surgery.

Sometimes a small amount of clear yellow fluid comes out of the wound after the sutures are taken out and the area is healing. If this happens, leave the wound open to the air to dry out or put a thin sterile gauze bandage over the wound.

Contact your surgeon if you notice any redness or swelling around your wound. You could have an infection.

Constipation

Constipation is when you have trouble having a bowel movement. It is normal to go one or two days without having a bowel movement but you can have problems if it is longer than this.

You are more likely to become constipated because you are taking pain medication, you are less active, and you might be eating different foods.

Ways to prevent constipation:

Drink at least 8 glasses of water or low-calorie fluid each day.
Eat lots of high-fibre foods (such as prunes, vegetables, bran, beans, lentils, and fruit).
Move around as much as you can.
Talk to your doctor about changing from an opioid (narcotic) pain medicine to a non-opioid pain medicine (without narcotics).
If you have had problems with constipation in the past, talk to a nurse or pharmacist about taking a stool softener before constipation becomes a problem. A stool softener (such as Colace) makes your bowel movements softer and easier.
If you do not have a bowel movement for a couple of days, talk to a nurse or pharmacist about taking a laxative. A laxative (such as Senekot) helps move your bowels.
Call your family doctor if you have not had a bowel movement for more than four days.

Follow-Up Visits

Your surgeon will write down when you need to come back to the clinic for follow-up. Most surgeons want to see you at 2 weeks, 6 weeks, and 12 weeks after your surgery.

Two weeks after your surgery, the surgeon takes your sutures out and checks to make sure your wound is healing the way it should.

If you have a cast, bring your walker boot to the first follow-up appointment.
If you live out of town, you might be able to arrange with your surgeon to have this first visit done by your family doctor.

You can book all your follow-up visits at the same time your surgery date is booked. If you didn’t do this, call your surgeon as soon as you get home from hospital, to book your follow-up visits.

At your follow-up visits, your surgeon and physiotherapist can tell you when you might be able to return to activities (such as doing more exercise, returning to work, etc).