Undergoing surgery can be confusing and on occasion slightly scary. Please take the time to read through this thoroughly as this answers many questions and concerns patients have when undergoing surgery of the foot or ankle and provides important instructions to safely provide the care needed for your foot and ankle for after your surgery.
Please note that a similar packet will be given to you on your preoperative appointment with Dr. Kikuchi in preparation for surgery.
Preparing for Surgery
- If you are notified by Dr. Kikuchi’s staff, call your primary care physician’s office to set up an appointment for your preoperative physical and lab tests, which must be done within 30 days of your surgery date. All results should be faxed to 808-356-5643.
- We will schedule an appointment for you 1-2 weeks prior to your surgery date to complete the necessary paperwork. We will go over the proper paperwork necessary as well as write your post operative prescriptions.
- It is important to fill you the prescriptions immediately, they will expire and some of these prescriptions cannot be called into the pharmacy due to drug enforcement laws and regulations.
- Often patients have last minute questions regarding their surgery. Please help us by writing down a list of questions you have so that Dr. Kikuchi and his team may answer these for you.
- Finally you will be given an instruction sheet outlining the place and time of your surgery.
The Day Before Surgery
- Do NOT eat or drink anything after 12 midnight the night before surgery, including mints, gum or candy.
- You may brush your teeth, but may NOT swallow any water. Your surgery will be cancelled if you eat or drink after midnight for safety reasons.
- Being under anesthesia with anything in your stomach places you at risk for complications.
- Do not consume alcohol for 24 hours prior to your surgery. Smoking and recreational drug use prior to surgery can lead to serious side effects under anesthesia.
- If provided to you by Dr. Kikuchi’s team, use the scrub brush the night before or the morning of your surgery. Clean your leg from your knee to your toes, being sure to scrub between the toes as well.
- You will need a responsible adult (18 years or older) to drive you home and to stay with you for at least 24 hours to assist you
The Day of Surgery
- Wear loose, comfortable clothing that can fit over a bulky dressing. Do not wear jeans.
- Give yourself plenty of time to get to surgery, find parking, and make your way to registration at either Minimally Invasive Surgery Center of Hawaii or Queens Medical Center.
- Review the instruction sheet given to you at your pre-operative appointment.
- Do not wear contact lenses, barrettes, hair pins or hair pieces.
- No make up, artificial fingernails, nail polish, jewelry, and watches should be worn to your surgery.
- Please bring a photo ID, insurance card and prescription card to your surgery check in.
- Bring a list of your current medications and drug / food allergies.
- Bring 3-4 pillows to elevate your foot on the ride home.
General Guidelines for Recovery after Surgery
- The following information can help you navigate your post operative recovery after your procedure with Dr. Kikuchi as orthopedic surgeries for the foot and ankle are different from other areas in the body and thus will react differently from other surgeries.
- If you are having surgery performed on the bones in your foot and ankle, you are not allowed to take any nonsteroidal / anti-inflammatory medications following surgery unless cleared to do so by Dr. Kikuchi. These medications can inhibit bone healing. The following medications fall into this category
- Naprosyn / Aleve
- Ibuprofen / Motrin / Advil
- If you do not have any liver problems, you may supplement your pain control with over the counter extra strength Tylenol.
- After surgery, you may be non-weightbearing for a period of time, varying from a day or two to several weeks. The length of time will depend on your specific procedure being performed.
- Non-weightbearing means that your foot MAY NOT touch the floor, even in a splint or boot. Any weight put on the healing bones or joints will adversely impact your recovery and cause your surgery to fail.
- You should be using assist devices to help you get around during you recovery after surgery, most times a pair of crutches or walker is sufficient. If you do not have the strength to utilize these devices, a wheelchair may be of benefit. A prescription for these devices may be needed depending on your health insurance carrier. These can be provided prior to surgery.
- Instead of a walker or crutches you may use a rolling knee scooter (KneeRover Scooter / Drive Medical DV8) or a walking knee crutch (iWalk 2.0). These items typically are not covered by insurance plans, but they are a great assistive device alternative to a walker or wheelchair. These items usually retail for 130-150 dollars on Amazon.com
- Typically, insurance plans will cover for only ONE assistive device, should you want multiple devices you may need to pay out of pocket for additional devices, please check with your insurance plan for additional information.
- Right Sided Foot or Ankle Surgery. IMPORTANT – PLEASE READ IF THIS APPLIES TO YOU. If you are having surgery on the right ankle or foot, typically this will mean you will be in a splint / boot / surgical shoe / cast during the first several weeks after surgery. Due to this, if you are having right sided ankle / foot surgery, it is Dr. Kikuchi’s policy that you cannot use the right foot to drive until cleared by Dr. Kikuchi. This is because during the early part of recovery using a foot / ankle that has had surgery on has been well documented to have unsafe braking response times as well as jeopardizing the work done to repair / correct your foot during the early recovery period. This poses not only a safety problem for you, but your loved ones and other motorists on the road. Most patients of course are highly concerned about this, however, if you have the means to do so, you can order temporary hand conversion controls for your car off of Amazon.com for 170-200 dollars. Insurance companies typically do NOT cover this item. The most common brands are QuicStick and FreedomStaff.
- You should decide which assistive device you would want to use and make arrangements BEFORE your surgery. Clinical staff can assist to take you to the curbside to be placed into a family member’s car or medical transport but you will need your devices when you get home.
Recovery Immediately After Surgery
- Once your surgery is completed, you will be taken to the recovery area while your anesthesia wears off. As you are waking up you may be sensitive to lights, noise and temperature.
- Nurses will be checking your vital signs frequently and does not mean anything is wrong as this is routine. You may experience side effects as a result of the anesthesia including nausea, shivering, sore throat or headache. Please let the nurses know if you experience these so they may assist you.
- Most patients receive a nerve block during surgery, which will numb the nerves that go down to the foot / ankle area. This block will last approximately 8-10 hours on average but can last up to 24-36 hours.
- When the nurses and anesthesiologist think you are ready, you will be discharged from the recovery area. If you are being admitted to the hospital after surgery, you will be taken up to your room. You will receive your discharge instructions when you are ready to go home.
Recovery from the Day after Surgery and Onward
- If you had surgery on your toes, it is important that you check the circulation of the toes more frequently. By pressing lightly on the toe, you will note that the color of the toe changes and gets a little pale (blanches). When you release the pressure on the toe returns to a more normal pink color (this is called capillary refill). The toes must not be dusky, pale or blue. If you notice any adverse changes, contact the office immediately.
DRAINAGE AND BLEEDING
- Drainage and bleeding after surgery is NORMAL. You may notice blood or drainage on the dressing or splint. It is OK to place extra gauze bandages over the dressing to reinforce it, but do NOT remove the dressing.
- If the blood or drainage continues to drip and the dressing is saturated with wet blood after the first 24 hours, please call our office.
- The type of dressing you will have after surgery depends on the type of surgery performed. On the day of surgery, you will receive specific verbal and written instructions about your dressing. If you have a splint, you will not have to do anything. Occasionally, if you have a small dressing, you may be instructed on how to change it prior to your first post-operative appointment with Dr. Kikuchi.
- Regardless of the type of dressing, you should not get the incision wet for 10-14 days. This interferes with proper healing and may result in infection.
- Do NOT get bandages wet while bathing. Cover your leg with a plastic wrap (usually 2 small / medium trash bags) with the open end taped water tight around your leg and a clean dry washcloth inside the bag covering the top of your bandage, and KEEP IT OUT OF THE TUB / SHOWER.
- Do NOT use premade over the counter cast covers / cast water protectors. These bags are known to tear quite easily and are not reliable and do not fit correctly over the post-surgical dressing and result in the bandages getting wet.
- If the post operative dressing gets wet, go IMMEDIATELY to an urgent care center or emergency room to have the dressing evaluated, which may need to be changed to prevent your wound from becoming infected.
- You will need to elevate your foot on 4-5 pillows when you are at home.
- Your foot will be swollen after surgery, elevation helps with pain control and is recommended for 5-7 days after surgery at minimum.
- During the first 5-7 days it is recommended that you limit ambulation (minimal walking) to walking between rooms (bathroom, kitchen, bedroom, living room). Even when switching rooms, continue to elevate the foot when you sit down.
- Also, avoid standing for long periods of time. Aching, throbbing and thumping is a strong sign that your foot needs to be elevated.
- Often times, Dr. Kikuchi will request the anesthesiologist to administer a numbing injection to your foot / ankle for the procedure to provide pain control. This block typically lasts 8-10 hours but can provide pain relief upwards of 24-36 hours. In certain cases it may last longer.
- It is advisable to begin taking your prescribed pain medication before your nerve block wears off. Preferably, start within a couple of hours after surgery and continue every 4 hours for the first 24-48 hours. Our goal is to provide you with comfort; however, you may still experience some pain. Medications should not be taken on an empty stomach.
- Weaning off medication. As your pain begins to diminish, begin to taper your medications by taking fewer pills or taking them less often as needed.
- Post-Op Nausea. You will also be prescribed a medication for the prevention of nausea during your post-op course. This medication should be used as needed.
- A side effect of pain medications is constipation. Senokot-S or Colace (over the counter) is recommended, if needed. Drinking plenty of fluids and eating fresh fruits and vegetables will also help with constipation.
- Medication refills. It is important that you don’t wait too long to call for new prescriptions of pain medication. These narcotic pain prescriptions cannot be called or faxed to your pharmacy due to federal drug enforcement laws and regulations. If you need a refill in 3-4 days please call our office and speak to one of Dr. Kikuchi’s staff members that you had surgery with Dr. Kikuchi, your specific procedure you had done, and your surgery date. This will help the staff members to provide better care for you. Staff members will then coordinate to either mail you the prescription or you will need to have someone to pick up the prescription at our office.