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Your journey: Post Surgery

Length of stay in hospital

You will be discharged from the hospital when your pain is manageable with oral analgesia, and when you are able to mobilise safely for care at home. For patients who may require short term inpatient rehabilitation or convalescent care post operatively, this will be assessed and organised by the hospital discharge planner – please inform Mr Tay when your surgery is being booked so that this can be prepared for. The following is a general guide for procedures and their usual required length of stay in hospital –

  • Day procedure ankle or shoulder arthroscopy without insertion of implants, endoscopic plantar fascia release, removal of metalware.
  • Overnight unilateral forefoot surgery, ankle ligament stabilisation, Achilles tendon surgery, fracture fixation, rotator cuff tendon repair.
  • Multiple days bilateral forefoot surgery, flatfoot reconstruction, mid-hindfoot or ankle fusion.
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    Pain relief

    Unfortunately, some pain is to be expected with any surgical procedure. Mr Tay’s anaesthetist will usually prescribe your analgesia during your stay in hospital and on discharge. This will aim to reduce (but not completely eliminate) your pain so that you are comfortable enough to rest and perform your essential activities of daily living. For certain procedures, it may be appropriate to consider a regional block with local anaesthetic, in addition to general anaesthesia for your surgery, to help manage your post operative pain. Unless contraindicated, you should take oral paracetamol and a non-steroidal anti-inflammatory (such as ibuprofen or diclofenac) regularly for pain relief. You will also receive stronger oral analgesia (such as an opioid medication) to take as well if necessary. You will be encouraged to wean off any prescription analgesia when able, typically by 2-4 weeks from your surgery.

        

    Dressings and suture removal

    Unless instructed otherwise, all surgical dressings are to be left intact and dry until your follow-up appointment with Mr Tay at approximately 2 weeks after your surgery. Interfering with your dressings, which were applied under sterile conditions, can increase your risk of wound infection. This may require you to cover your operated limb with a plastic bag when you shower to keep your dressings dry. Your skin sutures are removed during your first post-operative appointment with Mr Tay at 2 weeks. Once your dressings and sutures have been removed, you can wash without covering your surgical site. Do not actively remove any scabs and allow your wounds to dry up and mature naturally. You will be instructed to commence scar desensitisation at 3 weeks by massaging your wounds with a moisturising cream or oil to reduce any sensitivity of the operated area and scarring.

    CONTACT SLIDER CALL ONLY
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    Call 03 9002 4621 to make an appointment with Mr Wei-Han Tay.
    CONTACT SLIDER CALL ONLY
    Image is not available
    Call 03 9002 4621 to make an appointment with Mr Wei-Han Tay.

    Weight-bearing

    You may have weight-bearing restrictions through your operated limb to protect your tissue healing and surgical reconstruction. The following are typical examples –

  • Non-weight-bearing no loading or lifting through that limb with a gait aid to ambulate. For the upper limb, this means nothing heavier than holding a glass of water. This is normally limited to 6-8 weeks, before progressing to graduated partial to full weight-bearing. It is important to note that prolonged non-weight-bearing can also be counterproductive for healing and lead to deconditioning and disuse osteopenia (or softening of the bones).
  • Graduated partial to full weight-bearing gradual increase in the amount of loading or lifting through that limb with a gait aid to ambulate, normally over 6-8 weeks. This can be measured using a weighing scale to determine the approximate weight and increasing by that corresponding pressure through the limb every 1-2 weeks.
  • Protected full weight-bearing normal body weight with the support of a gait aid and or in an offloading footwear to ambulate. This is normally limited to 6-12 weeks
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    Gait aids

    You may need the support of a gait aid for ambulating after your foot or ankle surgery, depending on your weight-bearing status and ability to balance. Options include underarm or forearm crutches, a walking frame and or a knee scooter which may be hired or purchased. The physiotherapist will help assess which device is most suitable for you during your stay in hospital. Alternatively, you can seek advice from your community physiotherapist or podiatrist before your surgery and bring your chosen gait aid when you are admitted to hospital.

        

    Backslab/cast

    Your foot or ankle may require immobilisation in a below-knee backslab or cast after surgery, normally limited to 6-8 weeks. Mr Tay will apply a plaster backslab at the time of your surgery in the operating theatre. This may need to be replaced with a fibreglass cast at 2 weeks after review of your wounds. You must keep your backslab or cast intact and dry for the specified duration. This may require you to cover your backslab or cast with a plastic bag when you shower to keep it dry.

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    Comprehensive foot, ankle and Orthopaedic trauma care.
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    Comprehensive foot, ankle and Orthopaedic trauma care.

    Deep venous thrombosis prophylaxis

    Lower limb injury or surgery can increase your risk of developing a blood clot or deep venous thrombosis in your leg due to immobility. To reduce your risk, you will be encouraged to regularly move your ankle and toes on your operated side if possible, and to wear anti-embolism stockings if you are immobile for prolonged periods. You will also be advised to have daily subcutaneous injections with a heparin medication while your leg is immobilised in a backslab or cast, or to take low dose oral aspirin for certain ankle and hind-midfoot procedures, for up to 3 months.
        
    Please inform Mr Tay if you have had a previous deep venous thrombosis or pulmonary embolism, and or have a blood-clotting disorder, as you may require additional preventative measures.

        

    Footwear

    You may need to wear a special post-operative shoe or boot to offload your injury and protect your tissue healing after your surgery. Unless instructed otherwise, you are only required to wear your shoe or boot when you are ambulating; you do not need to have your shoe or boot on for showering or when you are sleeping. You will usually be instructed to transition back into normal supportive footwear by 2-3 months, depending on the operation that you have had. It is important to note that prolonged use of a post-operative shoe or boot can also lead to deconditioning and disuse osteopenia, and affect your gait and cause knee/hip/lower back pain. Prior to your surgery, Mr Tay will advise you regarding the following shoes or footwear aids that you may need –

  • Darco MedSurg shoe: a flat stiff sole shoe with a wide toe box and which can accommodate bulky bandaging for surgery involving the forefoot or plantar fascia.
  • Controlled ankle motion (CAM) boot a cushioned adjustable boot with a rigid shell that limits ankle and foot movement via a rocker sole. This device is commonly used for support and comfort after an ankle sprain or Achilles tendon injury and after mid-hindfoot or ankle surgery.
  • Normal supportive shoe:footwear for everyday use with inbuilt support for the longitudinal arch of the foot, an accommodative toe box and a cushioned rigid sole. A normal boot with the aforementioned features may also be worn to provide more support for the ankle and hindfoot. The type and brand of shoe that is most comfortable for you may vary depending on the shape of your foot or ankle. It is recommended that you remain diligent with supportive footwear following your surgery to optimise your long term results.
  • Medial arch support orthotic an insert placed in your CAM boot or normal shoe to provide specific support for the medial longitudinal arch of your foot after a flatfoot reconstruction or for surgery involving the midfoot or Lisfranc joint. This can be purchased off-the-shelf or custom-made by a podiatrist.
  • Ankle brace:can support the ankle via some semi-rigid stabilisation, compression and warmth. This can be used as an adjunct footwear aid when transitioning from a CAM boot back to normal shoes, and or when returning to playing sports.
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    Swelling

    Swelling of the operated limb is normal and to be expected after any foot or ankle surgery. Due to the dependent nature of the body area, the swelling in your foot and ankle can persist for up to 12 months following your operation. Rest and elevation of the limb is important, especially during the first 2-4 weeks after your surgery to reduce your pain and prevent excessive swelling which can lead to wound complications and stiffness. A compression bandage or stocking can also help manage your foot and ankle swelling once your surgical dressings have been removed.

        

    Physical therapy

    Where possible, you will be instructed to do early ankle and foot range of motion and stretching exercises. In particular, work on stretching your calf which commonly becomes tight with inactivity. Post shoulder surgery, you should continue to actively move your elbow, forearm, wrist, and hand to avoid stiffness in those joints.
        
    Once you are allowed to full weight-bear in normal supportive shoes, you can usually commence ankle and foot gradual strengthening and proprioception exercises. Mr Tay will refer you to a physiotherapist or podiatrist to guide you with your physical rehabilitation as required.

    CONTACT SLIDER CALL ONLY
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    Call 03 9002 4621 to make an appointment with Mr Wei-Han Tay.
    CONTACT SLIDER CALL ONLY
    Image is not available
    Call 03 9002 4621 to make an appointment with Mr Wei-Han Tay.

    Driving a car

    You should not drive a car if you are required to wear a post-operative shoe, CAM boot or broad arm sling. As a general guide, you will be safe to drive when you can mobilise your operated or injured limb without pain or restriction.

        

    Return to work/sports

    Your ability to return to work after your surgery will usually be limited by your pain, weight-bearing restrictions and need for immobilisation in a cast or post operative footwear. Except for minor procedures, you can generally return to work doing desk-based duties at the earliest at 2 weeks after your surgery and review of your wounds. You will be limited to suitable light duties at work while you have any weight-bearing restrictions, need the support of a gait aid, and or are required to wear a post operative shoe, CAM boot or broad arm sling.
        
    For most fractures and bony procedures needing internal fixation, or ligament and tendon injuries requiring surgical repair or reconstruction, you can gradually resume physical training (involving impact-loading or strain through the operated limb) or playing sports at the earliest at 3-4 months after your operation. However, it is recommended that you undergo appropriate physical rehabilitation prior to recommencing any sports or strenuous physical activity to avoid (re-)injury.
        
    Please note that the timeframe for return to work and playing sports can be subjective and also influenced by non-surgical factors, including social and financial circumstances.

        

    Medical certificates

    Please inform Mr Tay if you or your carer need a medical certificate because of your condition. Mr Tay will provide you with your medical certificate during your outpatient consultation or stay in hospital.
        
    For TAC and WorkSafe patients who are more than 8 weeks post their surgery and are awaiting their next review appointment, but require a Certificate of Capacity before then, please see your general practitioner or allied health therapist.

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