How to Prepare for Orthopaedic Foot or Ankle Surgery: Part I

Part I: Before Day of Surgery

Patients with orthopaedic foot or ankle conditions that need surgery are unique in their needs and considerations. This is because they have a wide variety of conditions which need different types of combined medical and surgical treatment.  Despite these differences, preparation and education about what to expect from surgery aids in doing well afterwards. 
This is a guide for patients to participate in their foot or ankle surgical treatment. Patients achieve the best results when they work with their surgeon to prepare for their surgery and post-surgical recovery. Part I will focus on what to do before your surgery.

Will patients need medical testing done before surgery?

Medical testing done for patients before surgery is known as pre-admission testing or PATs. PATs are done to check a patient’s physical or medical fitness before surgery. The nature of these tests is determined at the discretion of the surgical team. In almost all cases, such tests include blood samples from patients. Other PATs may include noninvasive heart examinations, a chest X-ray and/or a complete history and physical examination by a primary medical doctor.

Do certain medications need to be stopped before and/or after surgery? If so, then which ones?

Some medicines can be dangerous when taken just before or after surgery. Your surgeon will tell you which medicines must be stopped before or withheld after surgery. Your surgeon may tell you to stop taking:
  1. Aspirin before surgery. This drug can increase bleeding during surgery.
  2. Non-steroidal anti-inflammatory drugs (NSAIDs) before or after surgery. These medicines include ibuprofen (Advil and Motrin), naproxen (Aleve), and Celebrex and Mobic. These drugs can increase bleeding during surgery by decreasing one’s ability to clot blood. They can also slow down bone healing after surgery.
  3. Certain steroids before or after surgery. These can also slow down wound and/or bone healing after surgery.
  4. Hormone replacement therapy (HRT) and/or birth control pills (OCP) after surgery. These may increase the risk of having blood clots after surgery.
  5. Certain over-the-counter (OTC) supplements and/or herbal preparations before surgery. Many of these agents can increase bleeding during surgery.

Does the use of nicotine affect surgery?

Nicotine and other chemicals are contained in traditional and electronic cigarettes, cigars and chewing tobacco.  Nicotine from the use of any of these products can increase the risk of having problems after orthopaedic foot and ankle surgery. Nicotine slows down the flow of blood to and from the surgical foot and ankle. This effect of nicotine can increase the risk of developing bone, soft tissue and wound healing problems and/or infections after surgery. Slowing down the blood flow in one’s leg may also increase the chance of getting a blood clot or deep vein thrombosis (DVT) in that leg. To get the best results from orthopaedic foot and ankle surgery, patients should stop using nicotine-containing products well before surgery. Patients may need to discuss quitting with their surgeon and/or primary doctor.

What devices should be purchased to be used after surgery?

After orthopaedic foot or ankle surgery, many patients will not be allowed to put weight on their operated leg for a period of time. This is done at the discretion of the surgeon to allow patients to heal well after surgery. For patients to stay off of their operative leg, they will need to use some sort of device like crutches, traditional or knee walkers, or a wheelchair.
Considering that most patients won’t be allowed to walk or place weight on their operated leg after surgery, other devices may be needed to help in performing daily activities in the home. A bedside commode can be helpful if it is hard to get to the bathroom after surgery. If patients do not have a bathtub where they can sit down and prop their operated foot outside the tub, a shower chair or stool can help patients to cleanse their body while keeping weight off their operated leg in the shower.

Is physical therapy (PT) needed before surgery?

To walk smoothly and safely with an assistive device, many patients may need to receive training from a physical therapist. The surgeon may schedule a physical therapy (PT) session for patients just before surgery. This can prepare patients for surgery by getting them familiar with assistive devices and improving balance, arm strength and opposite leg strength. 

When must patients stop eating and drinking before surgery?

Patients aren’t allowed to eat or drink after 11:59 PM on the night before their day of surgery. This restriction also applies to chewing gum on the day of surgery. 

The reason for this is that patients must have as little food, drink or stomach acid in their stomach as possible at the time of anesthesia and surgery. Upon eating or drinking, it takes at least six to eight hours for food and/or drink to leave the stomach and enter the intestines. By having patients not eat or drink after 11:59 PM on the night before their day of surgery, their stomachs should be empty by the time of anesthesia and surgery. This decreases the chances that patients experience nausea, vomiting or an upset stomach with anesthesia.

If patients take certain medicines regularly in the morning, exceptions may be made to allow them to take their medication with small sips of water on the morning of surgery. However, patients should discuss their needs with their surgeon and anesthesiologist before surgery.
Part III: The Days After Your Surgery
The American Orthopaedic Foot & Ankle Society (AOFAS) offers information on this site as an educational service. The content of FootCareMD, including text, images and graphics, is for informational purposes only. The content is not intended to substitute for professional medical advice, diagnoses or treatments. If you need medical advice, use the "Find an Orthopaedic Foot & Ankle Surgeon" tool at the top of this page or contact your primary doctor.