Ankle Lateral Ligament Reconstruction: 1st Post-op

  1. You may shower tonight, letting soapy water run over your incision(s) and patting them dry with a towel. You should avoid submerging the leg (bath, pool, hot tub, etc.) for at least one week.
  2. You will begin progressive weightbearing in the walking boot over the course of one week. Please refer to the separate handout.
  3. Use an ace bandage or a thick sock to prevent the boot from rubbing on the incision(s).
  4. You should come out of the walking boot/brace and perform exercises to maximize your post-op ankle flexibility. You should perform the following exercises twice per day, once in the morning and once in the evening:
    • You should work on 3 sets of 15 reps of dorsiflexion (up), eversion (out) but avoid plantarflexion (down) and inversion (in) for now.
    • Stretch the Achilles by placing a towel across the ball of your foot and pulling up. Hold each stretch for a five-count and do five repetitions.
    • Plantarflexion (down) and inversion (in) may begin at 4 weeks post-op.
  5. In two weeks (4 weeks post-op), you will be allowed to transition out of the walking boot back into regular shoes with the assistance of an ankle brace. The ankle brace should be worn whenever weight bearing.
  6. Once you are out of the walking boot, you may resume straight-line, low-impact activities such as bicycling, walking, or working out on the elliptical trainer.
  7. You should continue taking the blood clot prevention medication (aspirin or equivalent) as prescribed until you are at least 4 weeks post-op.
  8. Physical therapy may begin at 4 weeks post-op. This will follow the checkpoints from the Accelerated Protocol (given today).
  9. I would like to see you back in 4 weeks for a follow-up appointment.

Lapidus Bunion Correction: 1st Post-op

  1. You may shower tonight, letting soapy water run over your incision(s) and patting them dry with a towel. You should avoid submerging the leg (bath, pool, hot tub, etc.) for at least one week.
  2. You will be strict non-weightbearing in the post-op shoe/boot while out of the house with limited heel-weight bearing while in the house.
  3. I have showed you in clinic today how to perform a bunion wrap to fine-tune the position of the toe. You should continue to perform this wrap daily. If you notice any drifting of the great toe towards the second toe, you may use tape as added fine-tuning. The bunion wrap should ALWAYS be in place unless you are showering.
  4. You will continue to ice and elevate the leg as much as possible. Elevating the leg above the level of the heart will reduce the amount of time required to bring down the swelling.
  5. I would like to see you back in 4 weeks for your next follow-up appointment. We will obtain new x-rays at that time. If there is appropriate evidence of healing, we will likely have you begin progressive weightbearing in the post-op shoe or walking boot.

Hindfoot Fusion: 1st Post-op

  1. You may shower tonight if you have a waterproof cast. Do NOT submerge the leg under water.
  2. You will be strict non-weightbearing in the cast.
  3. You should continue taking the blood clot prevention medication (aspirin or equivalent) as prescribed until you are at least 4 weeks post-op.
  4. I would like to see you back in 4 weeks for a follow-up appointment. We will obtain new x-rays at that time. If there is appropriate evidence of healing, we will likely have you begin progressive weightbearing in a boot.

Distal Chevron Bunion Correction: 1st Post-op

  1. You may shower tonight, letting soapy water run over your incision(s) and patting them dry with a towel. You should avoid submerging the leg (bath, pool, hot tub, etc.) for at least one week.
  2. You will remain heel-weightbearing in the post-op shoe for another 2 weeks. At 4 weeks post-op, you may transition to full-foot weight bearing in the flat post-op shoe, which will be provided to you today.
  3. I have showed you in clinic today how to perform a bunion wrap to fine-tune the position of the toe. You should continue to perform this wrap daily. If you notice any drifting of the great toe towards the second toe, you may use tape as added fine-tuning. The bunion wrap should ALWAYS be in place unless you are showering.
  4. You will continue to ice and elevate the leg as much as possible. Elevating the leg above the level of the heart will reduce the amount of time required to bring down the swelling.
  5. I would like to see you back in 4 weeks for your next follow-up appointment. We will obtain new x-rays at that time.

1st MTP Cheilectomy: 1st Post-op

  1. You may shower tonight, letting soapy water run over your incision(s) and patting them dry with a towel. You should avoid submerging the leg (bath, pool, hot tub, etc.) for at least one week.
  2. Continue to perform passive range of motion exercises of the great toe, at least twice per day.
    • Using your fingers, rapidly alternate between up and down for 2-3 minutes.
    • Slowly push to extremes of motion, holding for a 5-count. As your discomfort and sensitivity decrease, you may use the floor to push off for greater range of motion.
  3. You may wean out of the post-op shoe and back into regular supportive shoes as your swelling and scar sensitivity allows. Most patients are transitioning back into regular shoes at around 3-4 weeks post-op, but you may begin as tolerated.
  4. Use a dressing or a thick sock to prevent the post-op shoe from rubbing on the incision.
  5. Once you have returned to regular shoes, you may increase activities in a step-wise fashion.
    • I would like you to first become comfortable with activities of daily living before reintroducing straight-line, low-impact activities (walking, bicycling, or working out on the elliptical trainer).
    • Once you are comfortable at this level, you may then reintroduce higher-impact, straight-line activities (jogging and running).
    • The final step will be the addition of activities involving lateral movement and uneven ground.
  6. Continue to ice and elevate as needed.
  7. In 2 weeks, you may begin applying a scar cream (vitamin E based, such as Mederma) or silicone sheets.
  8. Physical therapy is not typically required, but can be initiated as soon as 2 weeks post-op if needed or desired.
  9. I would like to see you back in 4 weeks for your next follow-up appointment.