FAQs

This will depend on the type of surgery. Nearly all patients are kept non-weight bearing for the first 2-3 weeks to allow the wounds and incisions to heal. With fusion/arthrodesis type procedures, you must stay strictly non-weight bearing until you are clinically healed and there is no pain with palpation to the fused bones. This typically takes a minimum of 6 weeks and may be upwards of 3-6 months depending on how quickly the bones unite. Once a patient is clinically healed, we will typically advanced weight bearing 25% every 3-5 days until full weight bearing, with return to the previous weight level if pain occurs. At no point should patients “push through pain.” Doing so risks breaking the fusion site, creating a non-union, broken hardware, and possibly revision surgery.

This will depend on the type of surgery. If wounds are healed enough for sutures to be removed at 2-3 weeks post-op, we will generally allow the incisions to be exposed to a shower. Soap and water can be allowed to run down the extremity and the incisions patted dry. The incisions should not be soaked or submerged until a minimum of 4 weeks postoperatively and after all eschars (i.e. scabs) have fallen off. Soaking in the presence of a scab could allow bacteria to enter the wound and travel into the deeper layers of the wound.

This will depend on which extremity was operated on and the type of surgery. If it was your left foot, you may resume driving once you are off narcotic medications. If it was your right foot, the incisions will need to be healed and the foot must be strong enough to tolerate the pressure from a pedal without generating pain that might cause you to hesitate on the brake or gas pedal. Braking time is diminished for 8 weeks after ankle fracture repair and 9 weeks after ankle fracture. NOTE: From a medico-legal perspective, I never “clear” patients to drive. I will provide guidance when I feel your condition has healed enough that operating a motor vehicle will not harm your procedure. You must determine when you feel comfortable enough to resume driving without harming others.

Feet and ankles swell after surgery. While arteries pump blood into your lower extremity, the veins can only return blood with the aid of muscular contracture. With splint immobilization after surgery, it is no wonder patients experience swelling. Swelling is a normal healing response from the increased blood flow going to the site of injury. Some patients swell more than others. It is typical for feet and ankles to swell for the first 12 weeks after surgery, and some swelling may continue for the first year after surgery. If you had extensive incisions, some swelling may be permanent. Wearing compression stockings during the day can help return the fluid that builds up in the soft tissues and can discourage excessive swelling. Once the incisions are healed enough to remove stitches, compression socks can be worn. Elevating the operative extremity to heart level and flexing and fanning the toes can also help encourage the return of fluid from the extremity. If you are noticing swelling that is not improving overnight, is getting worse, and/or is accompanied by pain in the ankle/calf, this may be a sign of a deep vein thrombosis, or blood clot, and should be reported immediately for evaluation.

Probably. First, in order to decrease intraoperative and postoperative pain, many patients receive a lower extremity nerve block by the anesthesiologist or Dr. Wolf. This may last from a few hours to several days. During this time, it is especially imperative that you protect your limb since you cannot feel if it is banged or injured. No weight bearing is allowed while the extremity is numb and even after, clearance by Dr. Wolf is necessary.

Any incision on the foot or ankle cuts superficial unnamed nerves in the upper layers of skin. There will always be some loss of sensation at the site of the incision for the first few months after surgery. Typically, this improves over time from the periphery, like sod regrowing in a bare patch on a lawn.

If you had foot or ankle surgery, you may resume gym use after the wounds have healed sufficiently for the sutures to be removed at around 2-3 weeks. Going into a gym with fresh incisions increases the risk of infection. While you still have your post-surgical splint in place, strenuous activity that causes sweating into the dressing is discouraged. Pressure on the operated body part should be avoided until cleared by Dr. Wolf. If you would like to perform gentle bicycle kicks or straight leg raises after surgery to improve blood flow in your larger muscle groups, that is fine. No flexion or extension of the ankle should be performed while an ankle splint is in place, as this could cause excessive friction on incisions or weaken the splint support.

No solid foods should be consumed within 8 hours of the scheduled surgery time. You may have clear liquids (e.g. water, sports drinks, black coffee) until two hours prior to surgery. This will help keep you hydrated and hopefully make it easier to get your IV placed. If you are a regular coffee drinker, consuming your coffee (without cream) may also help prevent post-operative caffeine-withdrawal headaches. If you take diabetic medications like semaglutide (Ozempic), dulaglutide (Trulicity), or other GLP-1 agonists, you must only have clear liquids from 7pm two days prior to surgery. Continue clear liquids the day before surgery up until 4 hours before surgery. These drugs delay gastric emptying and could lead to aspiration if your stomach is not empty prior to surgery.

Please notify Dr. Wolf’s office as soon as you can after any falls. It is rare that a fall “messes up” the surgery, but we may want to have you come in to get repeat X-rays or to check out the condition of the splint or incisions. Even if a fall injures the surgery site, conservative therapy with splinting and continued non-weight bearing can sometimes allow you to proceed with a successful recovery.

If you were put on a low dose aspirin (81mg) twice daily after surgery as prophylaxis to prevent blood clots, you can generally discontinue this once you are allowed to weight bear. If you are not allowed to weight bear for 6 weeks after surgery, the aspirin is usually continued to prevent blood clots while you are non-ambulatory. Walking keeps blood flowing and prevents clots, but while immobile, particularly if in a boot, splint, or cast, the risk of clotting goes up, and aspirin can help decrease this risk by making your platelets less “sticky.” If you experience excessive bleeding or bruising, please notify our office.

You will typically receive a separate bill from your surgeon, the anesthesia provider, and the facility where you have surgery. If you would like to know how much your surgery will cost, we can provide you the CPT codes for the proposed procedures. With these codes, you can ask your insurance company for your expected out-of-pocket costs and the facility what they and the anesthesiologist will charge. Please note, that intra-operative findings will dictate the procedures performed and implants used. Thus, actual cost of surgery may increase or decrease from your estimate depending on the procedures performed and implants used. Dr. Wolf will try to be as cost-conscious as possible while providing you with the care you need and without sacrificing results.

Nicotine constricts blood vessels and deprives your tissues of blood and oxygen. This increases the likelihood that surgical incisions and fractures will not heal and increases infection rates. Nicotine use is the single greatest modifiable risk factor in most orthopedic surgeries. Because of the risks, it is not fair to you to proceed with elective or semi-elective procedures while utilizing nicotine. You will notice I use the term “use nicotine” and not “smoking.” All forms of nicotine (e.g. smoking, vaping, chewing, lozenges, patches, etc) increase the risks mentioned. You must discontinue all forms of nicotine for 4 weeks prior to surgery and pass a urine nicotine screening test. Passive exposure can cause a person to fail, so avoidance of secondhand smoke is recommended.

Approximately 70% of patient have their hardware for life after orthopedic surgery. The 30% that have it removed do so for various reasons including infection, irritation, aching, and breakage. Hardware removal, although routine, still has risks of surgical site infection, nerve injury, fracture, and anesthetic complications. Thus, if you successfully heal from your procedure and the hardware is not actively bothering you, it is reasonable to leave it alone.

The degree of anesthesia depends on you and the anesthesiologist. My only requirements are that you are 1) comfortable, 2) quiet, and 3) immobile. Surgery shouldn’t be painful if it can be avoided, and if it is too painful, you won’t be able to tolerate it or remain still. If you are talking excessively, it could lead to distractions during your surgery, which is obviously undesirable. Lastly, if you are moving during surgery because you are awake, this poses a safety issue for both you and the surgeon. I am always willing to try the least invasive means of anesthesia first, but if it isn’t achieving the three goals, we may need to change up the level of anesthetic.

Unless you had a finger, foot, or toe procedure, ice can be useful to control swelling. It is great on hips, knees, shoulders, and ankles. However, after ankle and foot surgery, there is usually a splint in place to protect the incisions and prevent motion. This well-padded splint limits the effectiveness of ice. Ice on feet and digits such as fingers and toes, can also impair blood flow to these areas we are trying to heal. Rather than cool the foot or ankle, gravity is more useful after surgery in reducing swelling. By raising the foot up to heart level this will help improve the return of blood to the heart and limit excessive extremity swelling. Gravity is superior to ice in this regard and doesn’t risk getting the split wet from condensation.

We will provide a short course of pain medication after surgery. Typically, this will consist of a narcotic medication to last 5-7 days after surgery. The goal of the mediation is not to “take away the pain,” which is impossible. The goal is to take the edge off and make it tolerable. A single refill will be provided if the first prescription is taken as prescribed, but further refills will need to be provided by your PCP or a pain specialist. We do not treat chronic pain at Treasure Valley Orthopedics and do not prescribe narcotics prior to surgery, except when surgery is eminent. Non-narcotic regimens are also available for certain surgeries and can be quite effective. It is also possible to start with a non-narcotic regimen with narcotic medication as backup.