Rehabilitation following forefoot surgery

This leaflet aims to guide you through the post -operative period. Please remember that this is a general guide and patients progress through this at different rate. Please discuss any concerns with me so that your individual circumstances can be considered.

What happens following the surgery?

Day 1

You will see the physiotherapist on the day of the surgery to learn how to use crutches and be fitted with a supportive shoe. I currently use a Podalux post op shoe (see below). This will provide support for the fusion or osteotomy but at the same time allow free movement of the ankle. Your foot will have lots of heavy bandaging after the surgery. You can take this off in bed or when at rest but use it when walking around. It is important not to put weight on the front of the foot to ‘toe off’ or go on ‘tip toes’ but you can freely and fully weight bear on the heel.

Regular elevation at heart level is essential although it is also important not to be confined to a chair or a bed for prolonged periods. I recommend around 20 minutes of elevation in every hour during the day and to have the foot elevated on pillows when sleeping.

Week 0-2

During this time, your foot is in the post-operative bulky bandaging. You should take things easy and avoid prolonged walking or standing as the foot will swell. The first 24 hours is relatively pain free as you will have a local aneasthetic block. Do make sure that you rake some of the provided painkillers before it wears off. Normally the pain is very manageable, and most patients do not require pain medication much beyond the first 5-7 days.

It is normal to occasionally see some dry blood on the bandaging underneath and some minor bruising.

Adhere to my rule of 20 minutes of elevation per hour and use the provided pain medications if required. Ankle exercises to maintain movement of the ankle and cause contraction of the calf will help with recovery and rehabilitation.

I will see you in the clinic at the two-week mark to remove the bandaging change the dressing and assess the wound.

Week 2-6

During this period, the bulky bandaging has been removed and you can therefore freely move the toes (if not had a fusion operation) and the ankle. You must continue heel weight bearing and avoiding weight on the forefoot and ‘toe off’.

You will be able to do more normal day to day activity including start going to work if your work is not too physical.

I will see you in clinic at the 6-week mark and review the X-rays to assess the healing. If it is healing, then you will be able to wear normal footwear although initially a pair of comfortable trainers is best.

Weeks 6-12

In this period, you will be returning to normal activities gradually and can restart all except high impact exercise such as jogging or jumping. I also recommend that you continue with trainers as swelling around the foot may persist in this period.

You may notice swelling and discomfort at the end of the day or after heavy use and may need to elevate your foot at the end of the day. These symptoms should resolve significantly by the end of this period.

Months 3-6

In this period higher impact exercise can be introduced gradually with the aim to resume pre-surgery activities by the end of this period.

Months 6 onwards

You should now be fully recovered from surgery. Some patients do report minor residual swelling after heavy use or exercise that will improve further up to a year.

Work

If you work from a desk and commuting is not difficult you can start work from week 1-2 onwards. You must have provisions to elevate your foot and to regularly take breaks. For jobs requiring lots of standing or walking then this is delayed to 4-6 weeks or after you are back to into normal footwear at 6 weeks. For some heavy manual works then delays up to 3 months post-surgery maybe necessary.

Driving

You should not drive whilst wearing the protective shoe for the first 6 weeks following the surgery. The only caveat is if the surgery was on your left foot and you drive an automatic car, in which case you can drive as soon as you feel comfortable to do so. You must check with your motor vehicle insurer before driving in any event. You must also be satisfied that you are in control of the car and are able to perform an emergency stop.

Bath and shower

You must keep the postoperative bandaging dry. Showering and washing is therefore only possible if you can cover the foot and making sure it is waterproof. There are various products on the market that can be used for this purpose.

Following the two-week appointment if the wound is dry and healed, then you can start getting it wet but making sure it is fully dried and covered after the shower. Please avoid Baths, swimming, or hot tubs for the first 6 week.