Wednesday, September 28, 2011

Seven Questions To Ask Your Podiatrist BEFORE Foot Surgery

You’ve made the big decision to have surgery on your foot. You will likely have an appointment with your podiatrist shortly before surgery to discuss the surgery, and you will also in most cases be asked to sign a consent form. Instead of just listening to your podiatrist tell you about the upcoming surgery, here are some questions you can him/her to make sure you understand all aspects of what will be happening before, during and after surgery.

Question #1: Is this surgery necessary? The follow up question to that is what would happen if the surgery was not performed. In most cases, foot surgery is elective. What I mean by elective is that while there may be good reasons to do the surgery, such as relieving pain, it is not mandatory that the surgery be performed. An example of a surgery that is not elective would be surgery to remove a ruptured appendix. So in the case of your bunion, for example, it may be important to perform the surgery to allow walking and wearing shoes without pain, but people can and do live with bunions. In the bunion example, perhaps your podiatrist will say that not performing the surgery will likely lead to progression of the bunion which will lead to more pain, and a more complicated surgery down the road to correct.

Question #2: What type of anesthesia will be used? For anesthesia, there are a few choices which you may want to discuss so that the experience of foot surgery is as comfortable as possible.

The first choice is local anesthesia, which means the area to have surgery is made numb by given an injection of a local anesthetic. This works very well for simple procedures, and in some instances, may be the preferred method for even more involved cases. It is very safe, and although the injection is uncomfortable, once the area is numb, you will feel no pain the remainder of the surgery. You will be able to hear what is going on, which can be disconcerting to some patients.

The second choice is called monitored anesthesia care. This is the type of anesthesia I usually use for most of my surgeries performed in a hospital or surgery center setting. Medication is given through an IV by an anesthesiologist to put the patient in a light sleep. Once the patient is asleep, the part of the foot that will be operated on is numbed by a local anesthetic. Then, during the procedure, the patient usually remains in a very light sleep. No breathing tube is used – the patient is able to breathe by him/herself. Typically, the patient is unaware of what is going on, hears no sounds, and when the procedure is done, wakes up to a numb foot feeling well-rested.

The third choice of anesthesia is general anesthesia. In this case, the patient is put totally asleep by the anesthesiologist. A breathing tube is put down the throat, and the procedure is done with no chance of the patient ever being aware of what is going on. Recovery following general anesthesia is a little longer, but this too is usually very well tolerated by patients. A sore throat afterwards is not uncommon. If I perform a surgery using general anesthesia, I will generally numb the foot at the end of the surgery so that the patient will have no pain for several hours afterwards.

What anesthesia is best for you? Talk over the choices with your doctor, and the two of you will come up with a plan for what will be best for your particular surgery.

Question #3: What restrictions will there be after surgery? Will you be able to walk on your foot? How much? Will you be able to get the foot wet? Will you have to wear any special shoes or perhaps a cast? If you cannot walk on your foot, what method of keeping weight off your foot will be used? (crutches, wheelchair, etc?)
If you will be using crutches, ask your doctor or his assistant to show you how to use them, particularly going up and down stairs.

Question #4: How long will I be off of work? This question will depend in large part on both the type of surgery performed, and the type of work you do. Someone who sits a desk for work all day will be able to return to work much sooner than someone who does extensive standing or walking as a part of their job. When your doctor gives you an estimate on when you’ll be able to return to work, please understand that it is just an estimate. Perhaps things will go very well, and you’ll be back to work sooner, or perhaps you will take a little longer. The period of time given will usually be an estimate on what most patients experience.

Question #5: How long will it be before I can return to my regular shoes and my normal activities? Again the answer to this question will depend on the surgery performed, the shoes you would like to wear, and the activities you plan on participating in.

Question #6: How will post-operative pain be managed? With any surgery, there will be discomfort in the period afterwards. Pain medication will help to decrease the pain, but will rarely make it go away completely. Ask what you can do to help control pain. This might include icing your foot, keeping it elevated, etc.

Question #7: Under what circumstances should you contact the doctor after surgery? From my perspective, I want patients to call me if there is bleeding that is excessive (coming through the bandage), the level of pain is unbearable, they injure the surgery site, or they get dressings wet that were supposed to be kept dry. However, you should feel free to contact your doctor whenever you have a serious concern.

Surgery is a partnership between the patient and the doctor, and best results are obtained when the patient fully understands the process and is committed to doing his or her part.

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