Ankle surgeries emphasize the realignment of the structure either around or after removal of the deformity. Various kinds of internal and external fixation devices—some temporary, others permanent—are often required to maintain the appropriate alignment during, and beyond, the healing process.

Ankle surgeries vary in complexity, length, and severity, yet many of them today are conducted on a same-day, outpatient basis. Patients need to arrange for another person to take them home afterwards and stay with them for the first 24 hours following the surgery. Post-operative instructions, provided by your surgeon, will give you the information needed to care for your recovering ankle following surgery.

Bunion surgeries fall into two major categories:

• Head procedures that treat the big toe joint. In a head procedure bunionectomy, the bone is cut just behind the joint, moved into its proper position, and fixed in place with a screw or pin. Head procedures are often used for patients who cannot be immobilized for long periods of time.
• Base procedures concentrate on the bone near or behind the big toe joint. Different types of base procedures are conducted depending on the nature of the deformity. These range from cutting a wedge out of the bone and splitting it so that it can be moved into its proper position; making a semi-circular cut and rotating the bone into its correct position; or fusing the joint. Ligaments inside and outside the toe may also be treated during a base procedure.

There are three important factors that impact the success of bunion surgery:

1. Choose a surgeon with extensive experience with bunionectomies. Because a deep understanding of the biomechanics of each patient’s foot as well as the intricacies of each surgical option is needed, surgeons with more experience at doing bunionectomies are better able to help each patient achieve the best outcome.
2. Be realistic in your expectation about what a bunionectomy can accomplish. No physician can guarantee that a bunion won’t recur or that a patient will be absolutely pain free. Additionally, because of the complexity of the foot structures impacted by a bunion, patients may never be able to wear normal or slender shoes. Bunion surgery can reduce or eliminate the bone deformity, improve foot alignment and function, and prevent damage to other toes, but it does have its limitations. Be sure you understand all the possibilities before opting for this surgery.
3. Bunion surgery is not a magic bullet.  Surgery alone may not be all that is needed to achieve your best outcome. After surgery, many patients experience long healing and recovery times and often have to spend time in physical therapy. Additionally, you may need a corrective orthotic device on an ongoing basis.

What To Expect

Most bunions surgeries today are performed on an outpatient basis at a surgical center or hospital. Set aside the entire day for the surgery, although you may only be at the facility for a half day.

Prior to the surgery, patients will need to make some preparatory arrangements. These include:

• Seeing your Primary Care Physician (PCP) to make sure any other health conditions are stabilized prior to surgery and to document your complete medical history, which can then be given to the foot surgeon.
• Arranging your schedule to make sure you don’t need to take any long trips for at least two to three weeks following the surgery.
• Lining up another person to drive you home and stay with you for the first 24 hours after the surgery.
• Stopping the use of any anti-inflammatory medications, such as aspirin, ibuprofen, or acetaminophen, for five to seven days before the surgery.

The night before the surgery, you will not be able to eat or drink anything after midnight. You should also wash your foot the night before and morning of the procedure to help reduce surrounding bacteria and prevent infection.

Bunion surgery is usually performed with a local anesthetic and is administered by an anesthesiologist. This may be combined with sedation medication to put you into “twilight” so that you are fully relaxed. After the surgery, patients are often given a long-acting anesthetic and pain medication, which is why someone else must drive the patient home.

The type of procedure you have will determine the degree to which you can put weight on the foot immediately after the surgery. Some patients, particularly those having base procedures, may have to use crutches; others may be sent home wearing a surgical shoe. The foot will be covered in a dressing, which you will need to keep dry for up to two weeks or until the sutures are removed.

During the first week after surgery, you will need to keep the foot elevated as much as possible. Ice packs also should be applied for the first three to four days to reduce swelling. Limited ambulation or walking is required over the first two weeks to promote healing. Most patients also are instructed on some basic exercises that need to be performed daily.

Sutures are generally removed about two weeks after the surgery in the doctor’s office. Once the sutures are removed, you can bathe and shower normally, but will still need to wear a dressing over the wound to keep it clean and prevent infection.

By the third or fourth week post surgery, swelling generally subsides enough for the patient to begin wearing a wide athletic shoe. It is important to continue daily exercises. If recommended, physical therapy may be initiated at this time. Once the wound has completely closed, you can use lotions to soften the skin in the surgical area.

By week five after the surgery, you will be able to walk short distances and do mild fitness activities. Continue following your surgeons instructions for increasing exercise and activities until you are back to normal.

Nerve Damage
Nerve damage, called Diabetic Neuropathy, can cause lack of feeling (pain, heat, cold) in the feet. This is dangerous because a diabetic may not feel a small cut or blister. The sore may get worse or infected because they are unaware that it is even there.

Poor Blood Flow
Poor blood flow is called Peripheral Vascular Disease (PVD). In a diabetic person the blood flow to legs and feet is reduced, making it harder for a sore to heal or for an infection to clear up. Diabetics who smoke have even more problems with PVD than non-smokers.

Foot Care
When a person has diabetes it is essential to have their feet checked by a health care provider at least once a year. (The feet should be checked more often if the person is experiencing foot problems.) A health care provider should be contacted if a diabetic notices cuts or breaks in the skin, ingrown nails, or noticeable changes in their feet. The health care provider should be the one to trim any corns or calluses.

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Most people are concerned about the health and appearance of their feet during the summer months, but by the time winter rolls around, feet are all but forgotten, shoved back into boots and heavy sneakers. We should be vigilant about foot care during the colder months, when falling temperatures, drier air, ice and snow and closed-toe shoes can contribute to foot problems. Here are some tips to keep you on your feet this winter:

1. Invest in some good shoes. Trying to put thick socks into thin summer sneakers isn’t the way to go. Good winter shoe should be waterproof, have enough room to fit two pairs of socks to insulate feet and prevent moisture buildup, and have a gripping sole to prevent slips and falls. For men and women who wear shoes that can easily get ruined in the wet, slushy streets of NYC, buy overshoes that can be slipped on over dress shoes as a way of keeping feet dry and warm and improving traction.
2. When purchasing socks, one pair should be a light synthetic ‘wick’ sock, to transfer moisture to a thicker wool outer sock, where it is absorbed and evaporated to the outside. Cotton socks absorb moisture and make for a soggy environment, which ultimately makes the feet cold and wet and sets them up for frostbite and athletes foot. Cotton socks are a great alternative to change into once in a warm, dry environment.
3. Lets try to keep our feet looking great, even though they are covered up most of the time in the colder months. Keeping toenails trimmed to avoid ingrown toenails, and to keep slathering on the lotion to avoid painful superficial and/or deep skin fissuring. Feet tend to dry out in the winter, which can cause cracks and peeling, so use a hypoallergenic lotion at least once a day to prevent irritation or infection from dry skin.
4. Watch your step when walking and keep an eye out on the streets, because cold weather leads to slippery surfaces and cracks in the sidewalk. Clear pavement can be covered in ice which you may not be able to see, so you need to pay attention, because a good shoe alone won’t be able to protect you.
5. Don’t make quick, sudden moves on slippery surfaces. Even if you don’t fall, you could pull or tear something, which may cause a foot or ankle sprain or strain. This can take weeks, or even months to heal, which makes for a not so happy winter.
6. Even we don’t see dramatically cold weather in NYC like some of our neighboring northern states, try not to stay out in the cold for too long. This can lead to numbness and pain in the toes and feet, which could mean the beginnings of frostbite. If this occurs, start by applying a warm towel and water to the affected area at the first sign of numbness, then seek a doctor’s care immediately to be sure to prevent any irreversible tissue damage.