Post-Surgery Guidance

First Days

        Your dressing is kept on until you come back for the check-up. However, if you bleed somewhat too much and the bandage is soaked in blood (not just a spot), call the nurse at the clinic and he will see you before the due date to change your dressing.

        You may put your weight on the heel of your foot as long as you wear the black post-op sandal (unless told otherwise: there can be cases where the bone is more fragile, and you may be told NOT to put weight your foot). If you have good previous experience with crutches, you may use those after single-foot surgery. Otherwise, do not rush and walk on your heel to avoid falling. Avoid walking on the side of your treated foot, since this instinct limp can cause other problems, such as hip and back pains.

        You may take the sandal off when you lie down. Those sandals do not have a right-or-left side: They all close on the right side! They will feel too small the first ten days (because of the dressing), and thereafter too big... the first few days, you might stick to them at all time. but after few days they get dirty; then put them only when you are walking.

        If both feet are operated , you will be safer using a walker the first few days

        Keep the operated foot up as often as possible during the first week. Ideally, you should place two or three pillows under the calf so your foot is higher than your heart. Move around your ankle and your toes, so as to reduce the swelling. Moving your foot reduces the risk of phlebitis. Later on, your foot will let you know when it needs to go back up on the pillows. For instance, if you have been standing for a while and feel some pressure, it means it’s time to lie down again.

        If you feel the elastic bandage is too tight, you may take it off and put it back on a little more loosely. If you still feel some tightness, you may cut the top of the white dressing (kling) with scissors(without taking it off) and then place back the elastic bandage not as tight. Do not take off the dressing before 48 hours have passed since the surgery even if you have bled a little. Change the eleastic bandage and put the fresh one on a little tighter. If you take the dressing off too soon, bleeding can become worse. Note the bleeding had never been a problem.

        Another information sheet will be handed to you together with medications after surgery. This sheet will explain how to take them and what side effects they can cause. The more intense after-surgery pain usually goes away 2 to 3 days after surgery in 95% of patients and with all the medication you are given before you leave the clinic, such pain should be tolerable. The other 5% have a really low pain threshold, and must take narcotics for about one week. I can assure you that the great majority of people I operated on have told me later on that they expected much worse, having heard all kinds of terrible rumors about this kind of surgery. Well, some are true! There used to be surgeons who would fit their patients with casts, or insert a big pin which would cross the joints, and they would remove these without anaesthesia at the outpatient clinic. On top of that, those who were operated on both feet at once were unable to walk for weeks. Thankfully, surgical bony fixation procedures nowadays are a lot kinder on the patients.

9 to 12 Days After Surgery

        Your stitches will be taken out. “Steri-strips” (made out of surgical paper) will be applied instead

        Once the stitches are gone, you can take a bath (if there are no wires in your toe) or a shower. Take off the bandage and keep the steri-strips in place for the first four days. You can cut the fraying ends. On the fifth day, you may remove all steri-strips.

        Try your best to walk normally, using your heel rather than the front of the foot. Avoid walking on the external edge of your foot since this might cause pain elsewhere (metatarsals, knee, lower back). Avoid also to stay standing; if you must be on your feet, walk. There are few patients who are told to avoid standing on their treated foot because their bone need more stability to heal well.

        A word to the wise : As soon as the first day after surgery, you are told to go ahead and try to wiggle your toes even though they can’t move much. This will reduce the swelling (edema) because the tiny muscles in your feet act as pumps on your blood circulation. The same goes for your ankle and knee, as this will prevent phlebitis (those are rare: 1 in 2000). Operating under local aenesthesia (ankle nerve block) also lowers the risk of phlebitis.   Most surgery on Hallux Valgus does not involve wires, unless the bone is very fragile, as in the case of osteoporosis.

        If you do have a wire, it will be safer to take showers rather than baths. Wiggle your toes, put the dressing back on afterwards (with a plaster to cover the end of the wire). Your wire will stay put for four weeks after surgery.

        Taking out a wire is usually not any more painful than having stitches taken out. The brown elastic bandage will keep a slight separation between the big tow and the second one for four weeks after surgery.    You should be able to insert a finger between the two toes. You won’t need the bandage after four weeks. You will notice that the separation between the toes looks exaggerated, but this is done on purpose and they will go back to normal six to eight weeks later.         Start the big toe drills slowly for 20 minutes in a warm bath. Push it up and down. When done, you may want to apply an ice bag or a cold “magic bag”.

4 Weeks After Surgery

        At this stage, you should be able to drive again. Some may be able to do this sooner. Be careful. You will know you can drive because you will be able to kick the floor without pain.

        Five weeks after surgery, the special sandal is not necessary any more for most patients, but some elect to keep it on for a few more weeks because it feels more comfortable. At first, you can wear wide sneaker-type shoes for a few weeks and then start wearing regular shoes. It might be a good idea to get yourself a cheap pair of boots a size bigger than your normal size. There is nothing wrong with that since you will want to allow for some residual swelling. You may notice that your foot swells more during the sixth week than it did during the fourth, but this is due to the fact that you are more active and stay standing more often!

        Do more intense exercise and more often

        Once (or, ideally, twice) a day, for 15 to 20 minutes in a warm bath, hold your toe with the thumb and index finger and push it up and down. Repeat. Then, do ballerina Demi-pointe, while your toe is on the ground, lift your heel slowly but steady. At first can be done sitting, then standing.

        Do not be surprised that your toe is swollen and painful when you have worked out. No pain, no gain. The drill is necessary so your toe will be able to move normally again. Not only can you put some ice on it, but you can also take some Advil (Ibuprophen) three times a day, on occasion. It will not only reduce pain and swelling, but make your toe more flexible.

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