If you have been told that you will need surgery to repair your foot or your ankle, you might feel overwhelmed by all of the scheduled procedures and the adjustments you will need to make to your life.

We will not sugar-coat anything: Orthopedic surgery and podiatric surgery are tough, and ankle surgery recovery takes hard work. But this is a well-worn path, and in our experience there is a precise way to go about preparing for surgery and recovery. It’s just a process, and you can check it off point by point.

We have broken our guide down into four sections: The first touches on what to do before surgery, and the other three deal with different physical and mental aspects of recovery. The before-surgery section functions like a set of checklists, so you can actually print off that section and check off each point as you get prepared. The other three sections contain information that will become more and less relevant during different phases of your recovery, so keep that information accessible.

Planning for Surgery

image by: https://www.flickr.com/photos/phalinn/

Patients with the fastest recovery times tend to be those who plan for their surgeries well in advance.

Planning sounds like a chore, especially if you feel as though your impending procedure is hanging over you like a cloud, but doing the following work ahead of time, while you are still mobile, will save you so many headaches during your ankle surgery recovery period. Ultimately, you will struggle less, recover faster and find it easier to keep a positive mindset while you heal.

Preparing Your Home

• Stock your refrigerator and pantry with a good two weeks’ worth of food, and make some meals to freeze. Here are 14 such recipes. This is a healthier option than having pizza or some other fast food delivered.
• Put any of the utensils and appliances you use everyday in the kitchen somewhere easily reachable. This includes your coffee maker, your toaster, some silverware, a bowl, plates and cups.
• Put away any throw rugs. They are too easy to trip on, especially when you are relying on a mobility device. If you have any exposed electrical cords on the floor, you will need to re-route those along the wall.
• If your living room is downstairs but your bedroom is upstairs, bring some blankets and pillows down so you can sleep on the couch. Getting up the stairs can take a great deal of energy, and the effort is not worth the risk when you are already sleepy.
• Wherever you sleep regularly, have the following nearby: A phone, a phone charger, a nightlight and a flashlight.
• A cardboard box can be used to relieve the downward pressure of your bed linens. Get one that is big enough that you can slide your foot into one opened end, and put it under the blankets near the foot of your bed.
• For your bath or shower, put a plastic chair or stable stool in there if one will fit, and buy a waterproof cast cover in advance. We actually sell both of these items here. Also, consider non-slip strips in your bath tub or shower.
• Stock up on movies, put together a good stack of reading materials, and consider something like a Netflix account if you don’t already have one; this will be a good time to do some binge-watching.
• Find all your baggy, comfortable clothes. Sweats are ideal because they slip easily over a cast.

 


Organizing Your Life For A Quick Ankle Surgery Recovery

• This is the time to get the mobility device(s) you think you will need. Practice with it/them in the days before your surgery.
• Speak with your surgeon ahead of time about advance directives in the unlikely event you become unable to make health care decisions for yourself. This is typically not an issue with foot or ankle surgery, but in the interest of covering all possible bases, you can learn more about advance directives here.
• Find people who can help you with daily chores. Friends and family can be a big help, but they may not always be available. Consider outsourcing one-off errands via TaskRabbit and arranging a cleaner for your home via Homejoy. Also, if you have a dog, try DogWalker.com to find someone who can come give your pet the exercise it needs.
• Driving is only going to be possible if you have an automatic transmission and have surgery on your left foot. Even then, it isn’t recommended. If you will need to get around where you live, make arrangements with a family member or friend who can give you a ride. Taxis are also a possibility, so save a few local taxi companies’ numbers into your phone.
• If you will need to drive yourself somewhere, go to your local DMV for a handicapped parking tag. You can find your state’s DMV website here.
• Make arrangements with your employer regarding sick leave and the possibility of working remotely. In most cases, patients are not cleared to return to work for at least 8 weeks. Complex surgeries may require 3–6 months off. Don’t forget to apply for temporary disability (here is how to do that). If you do plan to work remotely, wait at least a week after surgery to attempt that; the pain medication and after-effects of anesthesia will make concentrating difficult.

 


Pre-Surgery Diet and Medications

• Speak with your doctor early on about what medications you currently take. This includes vitamins and supplements. He/she will let you know whether you need to tweak your medication regiment in the days or weeks leading up to surgery. On the day of surgery, make sure you anesthesiologist also knows your medications. Do not neglect this step, as some medications can cause excessive bleeding or slow the healing process. Pain relievers and anti-inflammatory medicine, for example, need to be cut out at least 10 days before your surgery.
• You will have to stop smoking. Smoking can actually cause certain heart and lung complications when you are anesthetized as well as during surgery. Furthermore, it can slow the healing process both in your skin and your bones. Smoking alone can actually negatively affect the outcome of your surgery. Ask your doctor what smoking alternatives — such as patches or vaporizers — might be acceptable if you are unable to quit altogether.
• No drinking in the days before surgery. Alcohol plus pain medication is a potentially life-threatening combination. Alcohol can also interfere with the nutrients your body will need to heal.
• If you are dieting or taking weight-loss supplements, you will need to put that on pause starting two weeks before the day of your surgery. You will need a normal caloric intake to get well. You can offset that later with specific exercises that can be done while you recover. We will touch on those later.

 

What to Do the Day Before Your Surgery

• If you wear nail polish, make sure it is fully removed.
• Pack an overnight bag that includes a change of clothes, a toothbrush and toothpaste, deodorant and whatever else is part of your grooming routine.
• Shower the night before surgery.
• Don’t eat or drink after midnight the evening before surgery unless your anesthesiologist explicitly tells you to do so.

 

What to Do the Day of Your Surgery

• Shower in the morning.
• Again, no eating or drinking before surgery, not even morning coffee.
• If your anesthesiologist has told you to take any medication, do so now with only the tiniest sip of water.
• Leave any jewelry, piercings or valuables at home.
• Don’t wear makeup.
• Do wear comfortable, baggy clothing.
• Arrive 2 hours before your surgery is scheduled to begin.



Getting Healed

The keys to a successful recovery are rest and, above all else, keeping weight off your foot or ankle as it heals.

This section will show you specifically what you can do to make sure your recovery goes well. We are only concerned here with post-operative treatment. In the subsequent sections, we will show you what you can do to make this ankle surgery recovery process easier on yourself.

The Importance of Rest

• Rest limits the pressure and strain you would be putting on your ankle.
• Sleep lots. Sleep is restorative for our bodies, and during this time much of the physical healing around the bone and other tissues will take place. Don’t underestimate sleep’s importance.
• Your doctor will let you know when your foot or ankle can bear weight. Until then, don’t put any weight at all on it. Use your mobility device(s) to keep that foot elevated and off the ground. Any pressure on a foot or ankle that has been recently surgically repaired can compromise the success of your recovery.
• If you are finding it difficult to relax, first try a deep-breathing exercise: Find somewhere quiet and comfortable, breathe in deeply for 3 seconds, hold that breath for 2 seconds, then slowly exhale for 3 seconds. Repeat.

 

Swelling

• In the first days following surgery, you will need to keep your leg elevated most of the time. Keep your ankle above your waist, ideally 6 inches (15 cm) above your heart. This will alleviate swelling from blood circulation.
• Afterward, still keep your foot elevated as much as you can.
• Your doctor may give you a cold-circulation unit to help reduce swelling. Follow his/her instructions in using that device.
• Otherwise, ice is going to be very useful for you. Place crushed ice in a clean bag (you can also use frozen peas), and wrap it in a towel. Apply to you the skin, but do not leave it there for more than 10 minutes.
• “I typically recommend patients apply ice briefly (10 minutes per hour) behind the knee post-op while elevating the foot at least to the level of the heart, while reclining,” says Dr. Seth Rubenstein, a podiatrist in Reston, Virginia. “The surgical dressing is frequently too thick for ice to penetrate effectively.”
• Pink skin under the ice is normal, but red or white means you have applied the ice for too long and given yourself an ice burn. Check the skin periodically while icing to avoid this.

 

Dealing With the Wound’s Dressing

• Do not remove the bandage, the plaster cast (if you have one) or boot (if you have one).
• Do not get your foot or ankle wet at all.
• The bandage is designed to absorb any discharge from the incision your surgeon had to make. Some spotting is normal. That said, if the spotting spreads rapidly, call your doctor’s office immediately.
• In case something happens to the bandage — maybe you spill water or food on it, or you snare it and part of it comes off — call your doctor’s office immediately.
• Later on, your doctor will tell you when you can remove the bandage. Follow his/her orders for cleaning the surgical area, and do not put any lotions or cream on the incision.

 

Bathing

• To prevent your cast or bandages from getting wet, use your waterproof cast in the bath tub.
• Bath tubs are better than showers because you have more control over the water flow. If your waterproof cast leaks in the shower, it can quickly fill with water and cause major problems.
• Instead, waterproof your leg and simply hold it out of the water while you bathe.
• If you have had a procedure done on both ankles or feet, and both are healing, then you will have to take a sponge bath to avoid getting your bandages wet and/or bearing weight.
• Typically, the period in which you much avoid getting the wound wet lasts 10–14 days. Afterward, the bandages can be changed, and sutures or stitches can be removed.
• Even afterward, avoid submerging your foot or ankle in water for at least another two weeks. This means no swimming.
• If you have hardware such as a boot, you may have a six-week period in which you have to bathe with a waterproof cast.

 

Infection

With an incision that needs time to heal, infection can set in if you don’t take care of yourself. If you have been prescribed an antibiotic, take it according to the prescription.

Call your doctor’s office if you notice any of the following:

• Redness
• Swelling
• A foul odor
• Drainage from the incision site
• Chills
• A temperature of 101 degrees Fahrenheit or more

 

Taking Medicine

• Your doctor will give you pain medication immediately after surgery, as the anesthesia begins to wear off. For small to medium amounts of pain, a non-opioid pain reliever will likely be given. For medium to extra large pain, an opioid pain reliever may be given.
• Non-opioid pain relievers are familiar, like Tylenol. Don’t exceed a daily dosage of 3200 mg.

• Opioid pain relievers include morphine, codeine and oxycodone, among others. Follow your doctor’s directions exactly if you are given such pain relievers. Some notes on opioid pain relievers:

  • They can lower your blood pressure, and you might feel dizzy or sleepy when taking them.
  • They can give you an upset stomach. The best way to deal with this is to take opioid pain relievers with a full glass of water right after eating.
  • They can also make you constipated. See below for how to deal with constipation.
  • Take these kinds of medicine whole. Do not break up, crush or try to dissolve these pills.
  • Take your pain medication as you detect your pain escalating. Don’t wait until the pain becomes intense.
  • With your antibiotic, be sure to take all that was prescribed for you.
  • If you are taking birth control, you will need to use an additional contraceptive while you are taking your antibiotics.
  • The earlier advice about not drinking alcohol still applies during your ankle surgery recovery period, but even more so if you are on antibiotics.

 

Constipation From Pain Medicine

Many patients find they have trouble moving their bowels when taking opioid pain relievers. Here are some things you can do to avoid constipation:

• Drink 8 glasses of water per day.
• Eat high-fiber foods such as fruits, vegetables, bran, beans, lentils and prunes.
• Stay as mobile as reasonably possible.
• Talk to your nurse or pharmacist about a stool softener if constipation has been an issue in the past.
• If you do find yourself having trouble moving your bowels, ask your nurse or pharmacist about taking a laxative.
• If you have no bowel movements for 4 days, call your family doctor.

 

Things to Watch Out For

Complications from circulation can arise during your first weeks of recovery. Contact your doctor if you notice any of the following:

• Coldness in your foot or ankle
• A pale color in your foot or ankle
• Tingling or numbness
• A sharp increase in pain
• Toenail beds turning blue

 

Following Up

Most likely, your doctor will want to make an appointment with you for intervals of 2 weeks, 6 weeks and 12 weeks post-surgery. Use this time to address any issues and give feedback about what you are experiencing.

 

Staying Physically Healthy

image by: https://www.flickr.com/photos/louish/

For any of us, a post-surgery recovery period would interrupt our normal rhythms, and the healthy habits we’ve tried to maintain can fall by the wayside without a little vigilance. However, maintaining or building new healthy habits will go a long way to making recovery successful.

This is important to avoiding weight gain while you are off your feet. Your recovery period is going to be fairly sedentary, and it can be tempting to over-indulge on comfort foods during this time.

Here is how to avoid those pitfalls and stay physically healthy during your ankle surgery recovery.
 

Diet

Raise your protein intake. You need roughly 0.5 grams of protein per pound you weight. A 200-pound person needs about 100 grams of protein every day to fuel the healing process. Healthy sources of protein include eggs, fish, nuts and lentils. Here is an example of a protein-rich meal plan for a 170-pound adult (source):

• Breakfast: 2 eggs + 1 cup of yogurt = 23 grams of protein
• Snack: 1 ounce of cheese = 6 grams
• Lunch: One can of tuna = 40 grams
• Snack: 1 cup of milk = 7 grams
• Dinner: 3 ounces fish + ½ cup of lentils = 7 grams

You will need the following nutrients, which come naturally from a healthy diet of whole foods or can come from supplements:

• 1200 mg of calcium (food sources: dairy, spinach, broccoli, kale)
• Vitamin D (best sources: sunlight or supplements)
• 500 mg of vitamin C (food sources: oranges, kiwis, strawberries, broccoli, bell peppers)
• Zinc (food sources: oysters, beef, pork, dark poultry, crab)
• Omega-3 fatty acids (best sources: cold-water fish such as tuna and salmon, cod liver oil)

Track your calorie intake. Most women need 1200 calories per day when they do no exercise, and most men need 1500 on such days. Start from there, and raise your caloric intake levels as you begin to exercise more.

The best foods you can eat require minimal preparation. This includes raw fruits and vegetables as well as nuts.

Limit your intake of sugar and grains:

• The easiest place to start is soft drinks. Replace these with water, although you can indulge a glass of milk from time to time.
• Next, swap out any cookies, pastries or ice cream with fresh fruit.

Finally, avoid making bread or rice a major component in any meal.

 

Exercise

• You will have to focus on upper-body exercises while you heal. One of the best resources we have found is this 7-minute video by Laurel House that demonstrates a number of useful exercises a person can do in bed.
• Hand-held free weights are great for exercising when you have limited mobility. Start with curls. From a sitting position, you can also try holding the weight and lifting it above your head, then back down again. Try 20 repetitions like this.

 

Bad Habits to Avoid

• Smoking. Smoking constricts blood vessels and makes the physiological process of healing take more time. Cut smoking all together. If you need help doing so, ask your doctor about alternatives such as vaporizers or patches.
• Idle snacking. While eating potato chips or candy can be physically or emotionally gratifying, particularly when you are feeling frustrated or otherwise down, the negative health effects and the bad habits this reinforces could ultimately slow your recovery time and keep you off your feet for even longer.

 


Maintaining a Positive Mindset

Having to spend multiple weeks in recovery mode can become boring and demotivating, particularly for active people. But it doesn’t have to be. The trick is to simply approach the healing process with the right mindset.

This mindset has an offensive and a defensive component: You will need to actively try to fill your time with enriching or entertaining experiences, and you will also need to be mindful of certain pitfalls or bad habits that are easy to slip into.
 

Entertainment

• Most of us have one or two hobbies we simply cannot find the time to pursue. Now is that time. If you have books you have been meaning to read, unfinished scrapbooks or a video game that you could never beat, take this time to check that off your list.
• If you need a good book or two, check out this post from Mashable that lists 10 free audiobook download sites.
• Streaming video sites such as Netflix and Hulu are perfect for those times of the day when you simply lack energy to do anything more active. Of course, binge-watching TV or movies can slip into an unhealthy routine, but there is nothing wrong with catching up on a show or two you never had the chance to watch.
• You can also use this time to learn something new. Sites such as Coursera and Khan Academy offer free college-level courses taught by professors and experts. Sites such as LiveMocha offer free language instruction plus connect you with native speakers so you can practice that new skill.
• This is also a good time to reconnect with friends and loved ones, especially if most of your support network is far-flung. If calling is not an option, you can try reaching out via Skype or Google Hangouts.
• If you have the resources to do so, indulge yourself. Call up your hair stylist or barber to see whether they can make house calls. Do the same if you have a manicurist or a masseuse.

 

Inspiration

Chicago’s Rush Medical Center has some pretty inspiring stories from patients who have undergone orthopedic procedures. Let their stories demonstrate the power of having the right mindset going into surgery:

• There is the story of a Naperville missionary who got back to globetrotting months after a hip replacement.
• A 79-year-old Judo instructor who has had three hip replacements, a knee replacement and an ankle replacement.
• And a 63 year old who went hiking weeks after his third hip replacement.

 


Dealing With Post-Surgery Depression

Post-surgery depression is a very real and very serious problem, and it is complicated by the fact that doctors often fail to recognize it for what it is. Harvard Magazine covered this very problem 14 years ago.

The best way to deal with post-surgery depression at the moment seems to be anticipating it, and dealing with it head on before it actually becomes a problem. Before your surgery, speak with your doctor about options for treating potential post-surgery depression because you cannot know in advance whether it will become a complication during your recovery period.

While post-surgery depression strikes everyone differently, here are some common symptoms:

• Feelings of excessive fatigue
• Insomnia
• Significant changes in appetite and body weight
• Crying unexpectedly and often
• Thoughts of self-harm
• Loss of interest in activities previously enjoyed
• Low motivation for everything

Writer Lynn Beisner at Role Reboot touches on an even subtler way she has noticed post-surgery depression creep in on her: She says on post-op Day 2 or 3, a spike of pain sets in, and a wave of panic accompanies that pain, telling her she should never have consented to the surgery, and that the pain will never go away. Beisner says the worst part is she never actually feels depressed, at least in a classical sense, after surgery.

Here is a three-step process to keep in mind so you can be prepared for any signs of post-surgery depression:

• Step 1 is to simply recognize the subtle nature of the symptoms of post-surgery depression.
• Step 2 is to follow up on your doctor’s recommendations for treatment once the need becomes apparent. This can take the form of counseling or medication, or perhaps both.
• Step 3 brings all of our previous advice full-circle: Keep up a routine of exercise and healthy eating, and keep in touch with your network of friends and loved ones. Our guidelines not only promote a healthy healing process; they can help ward off depression itself.

 

Sources

http://mydoctor.kaiserpermanente.org/
http://www.anklefootmd.com/
http://www.kitchendaily.com/
http://www.cdh.org/
https://www.disability.gov/
http://blog.anklefootmd.com/
http://bcfootandankle.com/
https://patienteducation.osumc.edu/
https://www.virginiamason.org/Podiatry
http://www.orthofootankle.com/
http://www.orthofootankle.com/
http://www.livestrong.com/
http://www.podiatrytoday.com/
http://mashable.com/
http://www.rushortho.com/
http://harvardmagazine.com/
http://mental.healthguru.com/
http://www.rolereboot.org/