Pre-op physiotherapy and preparation for surgery.
- there are many things that you can do to prepare you for surgery.
- you are allowed to walk right after surgery, however, your mobility will
be limited.
- Stock your fridge with healthy food in preparation for surgery.
- If you have friends or family who are able to help, now is the time to ask for help.
- Please see the physiotherapist at our office, far in advance of the surgery.
The number one cause of injury post-surgery is patients falling
over because they are unsteady on their feet. If you do not fall after surgery
you are one step ahead of the game. The physiotherapist will teach you how
to use crutches, a cane, a knee scooter or iwalk (depending on your preference
and upper body strength). We will demonstrate use of the cold therapy unit.
- In general patients who use a cold therapy unit consistently find that they are
able to decrease their pain medication usage by 50% and approximately 10%
of patients take no pain medication. Please consider using one.
- Focus on a healthy diet in preparation for surgery.
- At the time of surgery I will be breaking and resetting several bones in your foot.
- Anything that you can eat that will help your bone to heal will help.
- I recommend: vitamin D drops - 2000 IU/day, 1 omlette per day, milk, cheese,
bone broth.
- Please note x-ray changes that demonstrate bone healing typically take a minimum of 3 months to appear / show evidence of callus formation. We allow you to weight bear before this.
- If you are concerned about slow bone healing there is the option of using a bone stimulator - however, this is not covered by OHIP.
- Swelling after surgery is normal, please see images below. In general the foot is swollen for a minimum of 4 months. If you need to fit into a shoe earlier than this - we recommend purchasing a larger shoe for temporary use.
- In general once we break a bone it takes - 6 weeks to heal, 12 weeks to heal strong and 1 year to forget.
- Please limit your intake of processed foods, junk food, fast food, sugar, artificial sweeteners, no soft drinks, and specifically no diet coke...
- If you are unable to dedicate time to your recovery - we do not recommend proceeding with surgery.
If you are interested in losing weight please continue reading:
- If you have time please read the book the Obesity Code by Dr. Jason Fung
https://www.amazon.ca/Obesity-Code-Unlocking-Secrets-Weight/dp/1771641258
If you are interested in losing weight please continue reading:
- If you have time please read the book the Obesity Code by Dr. Jason Fung
https://www.amazon.ca/Obesity-Code-Unlocking-Secrets-Weight/dp/1771641258
- If you are a diabetic I would consider reading the book the Diabetes Code by Dr. Jason
- If you are a diabetic I would recommend looking into purchasing a Free Style Libre CGM to better monitor your diabetes, the better your diabetic control the faster you will heal and this will also decrease your risk of infection.
- The Diet Doctor Website is also good to read:
https://www.dietdoctor.com/how-to-lose-weight
- There is also a good - Dr. Jason Fung support group on Facebook
1) Week 1-4
- Weight bearing as tolerated
- Rest, elevation, and ice / cold therapy as required
- Use prescribed pain medication as required. If you do not need it you
do not have to take it.
- Can use cast boot, post-op shoe, crutches, or knee scooter to help with
mobilization
- There is also a good - Dr. Jason Fung support group on Facebook
1) Week 1-4
- Weight bearing as tolerated
- Rest, elevation, and ice / cold therapy as required
- Use prescribed pain medication as required. If you do not need it you
do not have to take it.
- Can use cast boot, post-op shoe, crutches, or knee scooter to help with
mobilization
- Initial planned follow-up is at 3 to 4 weeks post-op
- Please do not remove the dressings.
- It is not uncommon to see some blood through the dressings.
- If you remove the dressings, you will see pins sticking out of your foot.
- If the pins come out by themselves, do not panic. Call the fracture clinic and come for an earlier follow-up.
- If you develop any problems - please notify the office or fracture clinic for earlier follow-up in the fracture clinic.
- If you develop swelling in your calf and / or become short of breath - please visit your local emergency department to rule out a deep vein thrombosis (DVT) or pulmonary embolism (PE).
2) Week 4
- Attend fracture clinic for pin removal.
- Start mobilization of 1st MTP joint and other MTP joints once pin / pins are removed.
- Range of motion exercises can either be performed at home, or
with the help of a physiotherapist or massage therapist.
3) Week 4-6
- After pin removal patient can take shower and clean foot.
- Please do not pick at scabs.
- If the scabs fall off and there is a raw area underneath, please
clean and apply polysporin, or your antiseptic of choice.
- Please continue with range of motion exercises.
- Continue cold therapy as required.
- Focus on healthy diet.
- Can transition out of boot and into a sandal or shoe with toe separator.
- Please note there is significant variation in the amount of swelling that patients
experience. In general the foot is swollen for 4 months.
- Patients can purchase a larger shoe or sandal so that they can mobilize
more easily.
4) Week 6-12
- Continue with mobilization exercises
- Transition to regular shoe as swelling allows.
- Use pain as your guide - you are allowed to do any activities within your
limits of pain and swelling.
- Continue to use sandal / shoe with toe separation.
- Rest, elevation, and ice / cold therapy a required.
- If we operated on your right foot - you can now consider return to driving.
The minimum standard for driving is that you need to be in a regular shoe,
and able to come to a full emergency stop. This usually occurs at 6-10 weeks
after surgery.
5) Week 12-24
- Continue with mobilization exercises.
2) Week 4
- Attend fracture clinic for pin removal.
- Start mobilization of 1st MTP joint and other MTP joints once pin / pins are removed.
- Range of motion exercises can either be performed at home, or
with the help of a physiotherapist or massage therapist.
3) Week 4-6
- After pin removal patient can take shower and clean foot.
- Please do not pick at scabs.
- If the scabs fall off and there is a raw area underneath, please
clean and apply polysporin, or your antiseptic of choice.
- Please continue with range of motion exercises.
- Continue cold therapy as required.
- Focus on healthy diet.
- Can transition out of boot and into a sandal or shoe with toe separator.
- Please note there is significant variation in the amount of swelling that patients
experience. In general the foot is swollen for 4 months.
- Patients can purchase a larger shoe or sandal so that they can mobilize
more easily.
4) Week 6-12
- Continue with mobilization exercises
- Transition to regular shoe as swelling allows.
- Use pain as your guide - you are allowed to do any activities within your
limits of pain and swelling.
- Continue to use sandal / shoe with toe separation.
- Rest, elevation, and ice / cold therapy a required.
- If we operated on your right foot - you can now consider return to driving.
The minimum standard for driving is that you need to be in a regular shoe,
and able to come to a full emergency stop. This usually occurs at 6-10 weeks
after surgery.
5) Week 12-24
- Continue with mobilization exercises.
- Rest, elevation, ice as required.
- Please note anytime you break a bone, in general it takes 6 weeks to heal,
12 weeks to heal strong, and 1 year to forget on average.
6) Week 24-52
- Continue with mobilization exercises.
- Swelling will continue to decrease with time. The average recovery / swelling
is approximately 4 months. However, after operating on 4000 cases over the
past 10 years I have learned that there is significant variability in how quickly or slowly patients heal.
- Hopefully you have forgotten about surgery at the 1 year mark.
- If you continue to have pain - Please let me know - we will continually reassess the foot at each post-op visit.
- In general - bunion surgery will improve the form and function of your foot,
however it will not make your foot perfect. Part of the problem is that our feet
are constantly changing with time. Look at a babies foot, look at your feet, and
then look at the feet of anyone over 90. In general you are born with a lot of
padding on your feet and you gradually lose this over time. The take home message
is that it is important to wear comfortable shoes.
- Please note anytime you break a bone, in general it takes 6 weeks to heal,
12 weeks to heal strong, and 1 year to forget on average.
6) Week 24-52
- Continue with mobilization exercises.
- Swelling will continue to decrease with time. The average recovery / swelling
is approximately 4 months. However, after operating on 4000 cases over the
past 10 years I have learned that there is significant variability in how quickly or slowly patients heal.
- Hopefully you have forgotten about surgery at the 1 year mark.
- If you continue to have pain - Please let me know - we will continually reassess the foot at each post-op visit.
- In general - bunion surgery will improve the form and function of your foot,
however it will not make your foot perfect. Part of the problem is that our feet
are constantly changing with time. Look at a babies foot, look at your feet, and
then look at the feet of anyone over 90. In general you are born with a lot of
padding on your feet and you gradually lose this over time. The take home message
is that it is important to wear comfortable shoes.
- If you continue to have stiffness and are not satisfied with the range of motion there is the option of using a range of motion brace - however, this is not covered by OHIP.
- If you are looking for perfect feet, please do not have surgery.
- If you are looking for better feet, please sign up for surgery.
- Please see images below for a realistic idea of how swollen the feet become.
- On the positive side, surgery has significantly improved of the past 10 years,
we have moved from a 5 cm incision, to a 2 cm incision, to now a 2 mm incision.
- If you have the time to recover - on average 4 months - you can potentially consider having foot surgery.
- If you are looking for perfect feet, please do not have surgery.
- If you are looking for better feet, please sign up for surgery.
- Please see images below for a realistic idea of how swollen the feet become.
- On the positive side, surgery has significantly improved of the past 10 years,
we have moved from a 5 cm incision, to a 2 cm incision, to now a 2 mm incision.
- If you have the time to recover - on average 4 months - you can potentially consider having foot surgery.
Risks with surgery are the following:
Infection, wound healing issues, recurrence, swelling, stiffness, non-union, mal-union, arthritis (leading to further surgery such as a 1st MTP fusion) , avascular necrosis, neurovascular injury (numbness, tingling, necrosis leading to the loss of a toe / foot) , tendon injury, arthritis, DVT (Deep Vein Thrombosis), PE (Pulmonary Embolism), MI (Myocardial Infarction), CVA (Cerebrovascular Accident).
