LONDON FOOT & ANKLE SURGERY
Mr Andy Roche MSc FRCS (Tr & Orth) Consultant Orthopaedic and Trauma Surgeon specialising
in Foot and Ankle Surgery and Reconstruction

Important General Surgical Information

Please inform the surgeons clinic if any of the following occur after surgery which could be suggestive of infection:

  • You are experiencing significant pain after the operation that cannot be controlled by pain-killers
  • You are feeling unwell or feverish
  • You develop significant swelling, redness or fluid leakage around the surgery site

Before your surgery

  • Please bring your own X-rays/scans to the hospital if you have them on disc/hard copy
  • Do not eat any food or drink any fluids for 6 HOURS before your scheduled surgical time. The exception to this is you are allowed to drink CLEAR PLAIN STILL WATER up to 2 hours prior to surgery.
  • Please inform the surgical team if since the last time you were reviewed in the clinic before your surgery you have any new cuts, abrasions or skin problems on the leg to be operated on. This can pose an infection risk and may mean the operation will have to be postponed.
  • Pack sensible clothes for after the surgery that can slip easily onto your leg e.g. loose fitting tracksuit bottoms or a skirt.
  • Ensure you have sensible flat footwear for the other foot (e.g. trainers or fitted shoes).
  • Ensure you have someone to take you home after the operation when you are due to be discharged.

In hospital

  • You will be given adequate pain relief or a prescription for such prior to discharge to ensure your comfort at home
  • You will be given clear instructions for follow-up and the hospital will ensure you are given a follow-up outpatient appointment before you depart for home
  • The therapists will assess your mobility prior to discharge to ensure you can manage safely at home or in a suitable environment with care provided.
  • You will usually not have to do anything with your bandaging until next seen by the surgeon. Anything different to this will be clearly explained to you.

What to expect in first 2 weeks after surgery

  • Swelling - Minimise this by keeping your foot elevated on pillows/cushions as much as possible
  • Pain - Pain will be minimised by keeping your foot elevated and taking pain killers as prescribed. In some operations Non Steroidal Anti Inflammatories (Voltarol, Diclofenac, Brufen, Ibuprofen) will not be suitable as they can, in some cases, potentially delay healing of bones together but your surgeon will clearly explain this to you as needed.
  • Bleeding - Some ooze through the bandages is normal. If it is continual and you have concerns please contact the clinic. Keeping your foot elevated will help.
  • Rest – Rest as much as possible, mobilising as instructed but generally only when necessary both indoors and out.
  • Avoid smoking

On follow-up

  • Specific instructions for each surgery are provided on the relevant pages on this website
  • Each operation has a very individual post-operative course with regards to weight bearing status, schedule of clinic follow-ups, schedule of X-Rays and post-operative physiotherapy.
  • As a general rule it takes a lot longer for swelling to settle in a foot or ankle following surgery than one expects, up to 12 months in fact.
  • Functional recovery times will vary for each patient. As a general rule by 3 months there are normally very positive signs of improvement. By 6 months patients should be comfortable with activities of daily living and by 12 months the vast majority of patients will have returned to full activities.
  • Complications may unfortunately arise, but as stated on each individual operation page on this website, they are quite rare.

Wearing normal shoes after foot and ankle surgery

Although each surgical procedure has estimated times to recovery, swelling reduction, normal walking and return to sports etc, patients are often surprised as to how long it can take to be able to get into their “normal” shoes. Depending on what the exact procedure has been some patients can take longer to get their normal shoes on than others. For example after 6 weeks following bunion surgery the surgeon would be happy for the patient to fit back into normal shoes, but in some cases this may take longer. It is therefore advisable when you are “able” to wear normal shoes that you first wear softer, wider fitting shoes like trainer type shoes and gradually move into narrower, firmer shoes if wanted.  

Driving after surgery

The following is an extract from the “FOR MEDICAL PRACTITIONERS, AT A GLANCE GUIDE TO THE CURRENT MEDICAL STANDARDS OF FITNESS TO DRIVE”

Issued by the Drivers medical group, DVLA, Swansea, 2013 Edition:

Drivers do not need to notify DVLA unless the medical conditions likely to affect safe driving persist for longer than 3 months after the date of surgery (but please see Neurological and Cardiovascular Disorders Sections for exceptions). Therefore, licence holders wishing to drive after surgery should establish with their own doctors when it is safe to do so. Any decision regarding returning to driving must take into account several issues. These include recovery from the surgical procedure, recovery from anaesthesia, the distracting effect of pain, impairment due to analgesia (sedation and cognitive impairment), as well as any physical restrictions due to the surgery, underlying condition, or other co-morbid conditions. It is the responsibility of the driver to ensure that he/she is in control of the vehicle at all times and to be able to demonstrate that is so, if stopped by the police. Drivers should check their insurance policy before returning to drive after surgery.

It is therefore the responsibility of the driver to contact their insurer and to ensure they are fit to drive the car and can prove they are in control of the vehicle at all times. There is no other national standard for post-surgical patients or their doctors other than what is written above. Full guidance on driving with any medical condition can be found by clicking here.

As a clinical guide, if you can stamp your feet firmly down i.e. when performing an emergency stop, and you can depress the pedals individually and safely with your feet then you are potentially fit to drive. Your doctor will guide you more on this. Patients who have surgery on their left foot and drive automatics can potentially return to driving sooner than those with foot pedal controlled clutches.

Returning to work after surgery

  • Please see the relevant operation page for GUIDANCE on when you may be able to return to work. Everyone and every job is different.
  • Each surgery is very different and possibly a more manual and active job will take longer to return to than a sedentary position.
  • It is important to appreciate that commuting to and from work should be taken into account when planning a return to employment and this may be affected by your rehabilitation or immobilisation.

Flying after surgery

  • Contact your airline and inform them of your post-operative recovery/plan for immobilization/plaster cast as each airline has different policies
  • Generally the risk of DVT (deep vein thrombosis/blood clot) from flying is very low however risk factors exist that if combined together can potentially increase your risk of DVT. These risk factors include:
    • Age over 60
    • Smoker 
    • Immobility, for example, if you have had an operation or prolonged bed rest
    • Travelling for long distances with restricted leg movement 
    • Previous history of a blood clot  
    • Family history of blood clots  
    • Inherited condition causing your blood to clot more easily
    • Obesity 
    • Cancer, Chronic heart disease, inflammatory bowel disease, kidney disease or other long-term illnesses 
    • Contraception pill that contains oestrogen, or hormone replacement therapy (HRT) 
    • Pregnancy
  • It is generally not advisable to fly soon after surgery because your foot or ankle can swell which may adversely affect wound healing and your immobility could predispose you to a DVT. If in a boot/plaster it is advisable to wait until the boot/plaster is removed and your mobility regained.
  • Should it be necessary to fly shortly after surgery, your surgeon will advise if extra medication is required to reduce the risk of clot formation.
  • To reduce your risk of clots, follow general guidelines on international travel by air (WHO TRAVEL BY AIR HEALTH CONSIDERATIONS)

Important last note

This document is only meant to be a guideline to help you understand your treatment and what to expect. Every person is different and your rehabilitation may be quicker and slower. This will be advised and guided by your doctor and physiotherapist.

  • Chelsea & Westminster Hospital NHS
  • The Lister Hospital, Chelsea
  • Fortius Clinic
  • Bupa Cromwell Road