I’ve Heard Foot & Ankle Surgery is the Most Painful Thing Ever, is that True?
Dr. Christopher Hyer
Foot & Ankle Specialist
Ortho Montana-Bozeman
Many patients put off foot and surgery for years because of horror stories they’ve heard of the pain their friend or family member had from bunion surgery. Certainly, if we can handle the foot or ankle problem without surgery, that’s great, and we should do that. But, there are some cases where the problem continues to get worse and more painful and just can’t be fixed without surgery.
Of course, any surgery can be painful, but we have learned a lot about acute surgical pain control and especially pain after lower extremity/foot & ankle surgery. Let me share a few of the treatment and philosophical changes that have really made a tremendous difference in out-patient foot and ankle surgery. With these strategies and understanding, nearly 100% of foot and ankle surgeries are done as an out-patient/go home, same day surgery and only have use of limited amount of pain medicine for a few days.
1st-Acute Surgical Pain is Best Treated Pre-Emptive and Preventatively and Not Reactive.
- Most of our foot & ankle surgery can be done with what’s called a regional anesthetic nerve block. Think of an epidural in the back used in childbirth but here, it’s done behind your knee after you are already sedated and relaxed (and you don’t get a baby to take home afterwards 😊). This block numbs up the nerves from the knee down and puts them asleep before any surgery is ever done. Often these blocks can last 12-24 hours after surgery and there are also now long-acting anesthetics which last up to 36 hours that can be also used around the surgery sites to extend the anesthesia.
- A big mistake that some patients make is they don’t want to take any pain medicine at all, so they wait until they are 10 out of 10 pain.
This is exactly the opposite of what we want to do post-operatively. If you wait until 10 out of 10 pain, you’ll end up take lots of pain medicine in a short time and you’ll be chasing the pain control. Additionally, you’ll much more likely get the nausea/vomiting side effect from the pain meds making it even harder to take them. Ideally, we want to take the medicine pre-emptively before the nerve block wears off, so we can stay ahead of the intense pain.
2nd– Swelling is a Big Pain Generator in Foot and Ankle Injury and Surgery.
- The foot is the lowest part of the body and gravity is working against us. Any time the foot is below the heart, blood and swelling is going down-hill and you’ll feel more thumping, throbbing and pain. Pain medicine doesn’t cover this up. You have to keep the foot elevated at least heart level high or higher and especially in the first 36 hours after the injury or surgery. Ice and cold therapy are also super useful and your friends to reduce swelling and discomfort.
3rd-Another Big Focus Now is to Use a ‘Multi-Modal’ Approach to Pain Management.
- This means to prevent and treat pain from multiple directions, not just trying pain medicine to cover it up. The ice/cold and elevation are part of this approach. So is the regional anesthetic block done before your body ever feels any pain. We’ll also often use an anti-inflammatory medicine to help reduce swelling and pain as a non-narcotic tool. All in all, we want a very limited need for narcotic pain medicine.
- So, if we can have the nerve block working before any surgery is started, use elevation, cold and anti-inflammatory post-op to control the swelling and lightly use the pain medicine ahead of the nerve block wearing off, the vast majority of foot and ankle surgeries are quite tolerable and manageable.
- Again, it is a surgery and there will be some pain but typically very tolerable and controllable with these strategies.
- The expectation with this multi-modal pain management approach is that narcotic pain medicine would be used very limitedly and short term for no more than 5 days and then just back to taking over the counter pain relievers.
4th– Physical Therapy Modalities Used as Early as Possible In the Post-Op Phase
- Once early healing of the surgery or injury has occurred, early range of motion and direct care modalities with physical therapy can both reduce pain and swelling and speed and improve the overall outcome and recovery.
- Sometimes patients want to try to do this at home and on their own, which might be fine in a limited fashion after you are further along in the recovery, but there is a huge benefit to having hands on, expert level care in the early post-operative phase which ultimately speeds your recovery and improves your outcome. This also gives you another set of eyes to let you know what is normal and what is to be expected as you progress through the recovery.
Certainly, surgery for your foot and ankle problem will only be carefully considered when it’s the best option to deal with the issue at hand. Part of a successful surgery is the management and optimization of the post-operative recovery phase, this includes a pro-active approach to post-op pain management and rehabilitation. So don’t let the fear of pain hold you back from getting the treatment that will enable you to enjoy a more active life moving forward.
Dr. Hyer is a fellowship-trained foot & ankle surgeon with Ortho Montana-Bozeman.
https://montanabones.com/team/christopher-f-hyer-dpm/
View this article in the Bozeman Daily Chronicle