What will the surgery involve?
i. Anaesthetic - usually a general anaesthetic is required; as well as this, local anaesthetic will usually be placed around the knee close to the nerves that provide the sensation to your ankle and foot (popliteal nerve block). This will mean that the foot and ankle are likely to be numb when you wake after the surgery- this lack of sensation usually lasts between 12 and 24 hours. You will have a chance to discuss your anaesthetic with the anaesthetist before the operation.
one longitudinal incision is made on the inside of the foot
a further oblique incision is made on the outside of the foot
a further small incision is made at the back of the ankle to insert another screw
sometimes small incisions are required over the back of the Achilles tendon to lengthen it
iii. The surgery - The position of three joints under and in front of the ankle is corrected. The joint surfaces are also prepared in a way that should allow them to join together (fuse) and are fixed together with screws
iv. Stitches - Removable, non-dissolving sutures will be used to close the skin. These will be removed at your appointment about two weeks after surgery.
v. Dressings - Special dressings will be placed on the ankle and a plaster ’back slab’ will be applied, these should all be left in place until you are reviewed in the clinic at two weeks following the operation.
The plaster should be kept dry, applying a waterproof cover when showering is useful, the most commonly used can be found at www.limboproducts.co.uk
What happens after the surgery?
i. Going home - This is usually the morning following surgery depending on how easy you find using the crutches and your home situation (i.e. how many stairs you have).
ii. Pain relief - The local anaesthetic ankle should provide some pain relief, but you will be supplied with pain relieving tablets by the hospital (usually co-codamol or paracetamol and tramadol) these should be taken regularly initially. You can gradually reduce these after a couple of days as your pain allows. You should avoid non steroidal anti-inflammatory tablets eg. nurofen as these could stop the bones joining/ fusing.
You will find it more comfortable to keep your foot elevated, if possible above the level of your heart, as much as you can for the first two weeks after surgery. This will help reduce the swelling and therefore also help wound healing.
iii. Walking - The amount of weight you will be able to apply through the foot/ ankle is as follows:
Weeks 0-6 No weight
Weeks 6-12 Gradual increase to full weight bearing in plaster or removable boot.
iv. Follow up - You will be reviewed in the outpatient clinic at:
2 weeks after surgery when dressings and plaster and sutures will be removed and a new plaster applied.
6 weeks after surgery, when the plaster will be changed to a weight bearing plaster or a walking boot.
12 weeks after surgery when an X-Ray will be taken and if satisfactory then you will be able to remove the boot.
6 months after surgery, further follow up will then depend on your progress.
v. Driving - If you the surgery is on your left ankle and you have an automatic car you may be able to drive two weeks after surgery, but you should check with your insurance company first.
If the surgery is on your right ankle you will not be able to drive until you can walk without crutches (or boot/ plaster) confidently. At this point you should check that you can place your foot on the pedal with sufficient force to do an emergency stop without pain, this should be tried in a stationary car; if you are able to do this you should then contact your insurance company to ensure that they will provide cover for you.
vi. Return to work - Approximately:
Office job - 6 weeks
Mobile job requiring driving - 12-14 weeks
Manual labour - 4 months
What are the risks of the operation?
There are a small number of risks of surgery including infection, nerve damage, blood clots, ongoing pain and the need for further surgery (please see General Risks of Foot and Ankle Surgery for further information)