Before surgery
Operations on the foot, ankle and lower leg range from day surgery, such as removing a plate and screws, to larger operations such as repairing a torn Achilles tendon or fixing a fracture with plates and screws. Bone and tendon surgery in this area can be painful for the first few days, so pain relief is planned before your operation.
Fasting and medicines work the same way as for any operation. Open each one to work it out here, without leaving the page.
If you have been injured and your operation is booked at short notice, tell the hospital about any blood thinners or diabetes medicines as soon as you can.
Anaesthetic plan
| Part | What it involves |
|---|---|
| General anaesthetic (GA) | Most of these operations are done with you fully asleep. Some operations on the Achilles tendon and hamstring are done with you lying face down, and you are positioned carefully once you are asleep. |
| Nerve block | Using ultrasound, I inject local anaesthetic around the nerves that supply the area being operated on. For the foot and ankle this is usually a block behind the knee (popliteal sciatic block), sometimes with a second injection on the inside of the thigh (saphenous or adductor canal block). The block is usually placed before surgery, after you are given medicine to relax you. |
| Spinal anaesthetic | An alternative for some people and some operations. An injection in the lower back numbs you from the waist down, usually with sedation so you are relaxed or asleep. See spinal anaesthetic. |
| Local anaesthetic from the surgeon | Your surgeon may also inject numbing medicine into the wound. |
The approach is tailored to your operation, your health and your preferences. More detail is on the nerve blocks page.
Medications during surgery
- Strong pain relief (opioids): given through your drip during the operation and in recovery if needed.
- Dexamethasone: a steroid that reduces swelling and nausea and can help the block last longer.
- Anti-inflammatory medicine: such as parecoxib, if it is safe for you.
- Antiemetics: to reduce the chance of nausea or vomiting.
- Antibiotics: given before the operation when your surgeon uses plates, screws or other implants.
When the block wears off
A nerve block for foot and ankle surgery often keeps the area numb for many hours, sometimes into the next day. How long it lasts varies from person to person. When it wears off, pain can come on fairly quickly, often in the evening or overnight.
- Take your regular pain relief on time from the first evening, even if you feel no pain yet.
- When you first notice tingling or the feeling returning, take your stronger pain relief if you have been prescribed it.
- Keep your leg raised above the level of your heart as much as you can. This reduces swelling and throbbing.
After surgery
Regular pain relief
- Paracetamol taken regularly.
- An anti-inflammatory medicine if it is safe for you.
Additional pain relief
- A stronger medicine for short-term use when the regular medicines are not enough.
- Medicine for nausea and constipation if you need it.
Looking after a numb leg
- You cannot feel pressure, heat or cold while the leg is numb. Keep it away from heaters and hot water bottles, and check that your cast, splint or boot is not pressing anywhere.
- Your leg may be weak. Use your crutches or frame and follow the weight-bearing instructions from your surgeon and physiotherapist exactly.
- Have someone with you when you first get up and walk.
Side effects and risks
- Temporary numbness and weakness of the foot and leg while the block works. This is expected.
- Incomplete pain relief from the block, treated with other medicines.
- Bruising or bleeding where the injection was given.
- Infection (rare).
- Nerve irritation, tingling or a numb patch that lasts weeks or months (uncommon), and permanent nerve damage (very rare).
- Drowsiness, nausea and constipation from stronger pain medicines.
You are always free to decline a nerve block. The alternative is pain relief by tablets and through the drip, with local anaesthetic from your surgeon.
When to get help
Contact your surgeon or the hospital straight away, or call 000 in an emergency, if you have:
- pain that keeps getting worse despite your medicines, especially with a tight cast or splint
- numbness or weakness that has not started to wear off by the time you were told, or comes back after it went
- a fever, or redness or discharge from the wound
- pain or swelling in your calf, chest pain or shortness of breath.
Safety and monitoring
- You must not drive, operate machinery or make important decisions for 24 hours after a general anaesthetic. Your surgeon will tell you when you can drive again, which is usually much later after foot and ankle surgery.
- Your pain relief will be reviewed before you go home.