This information has been designed to give you and your family some basic information about foot surgery and what you can expect to happen before and after the operation. This information is intended as a guideline, you may have many more questions which the doctors, nurses, physiotherapists and occupational therapists will only be too happy to answer any questions you may have.

Why is the operation necessary?

Most foot operations are designed to relieve pain and stiffness or correct deformity. Foot surgery can be quite complicated and your surgeon and/or Foot and Ankle Nurse Practitioner will explain this to you fully before your operation.

You will usually be admitted to the ward the day before surgery. This type of surgery is also required in some cases following trauma in which case you will be admitted to the ward from the Accident and Emergency Department.

The nursing staff will meet you, explain the layout of the ward and introduce you to your named nurse. They will ask you a number of questions, so that they can cater for any individual needs you may have.

The ward doctor or Nurse Practitioners will see you and arrange for your pre-operation tests. These are usually an examination, an x-ray and blood tests.

The surgeon and anaesthetist will see you before your operation to examine you and answer any questions you may have. The surgeon will discuss with you the nature of the surgery, outline the associated risks and obtain your informed consent. The anaesthetist will discuss the type of anaesthetic best suited to you.
The procedure may be performed under general anaesthetic; a local anaesthetic block is also sometimes used. The different forms of anaesthetic will be explained to you and you will be given the opportunity to ask questions.

The physiotherapist will come and see you before the operation to assess your level of mobility and to teach you the exercises you need to do after the operation, to help you recover.

The most important preparation is for you to understand what your operation involves and for you to feel comfortable with your decision. Remember that staff are here to help you and answer any questions you may have.

What problems can occur?

No operation is without the risk of complication. Your surgeon and the Foot and Ankle Nurse Practitioner will explain any particular risks/complications of your operation before surgery.

Swelling is common after surgery and might be treated by elevation.

Is the operation always successful?

The opportunity to explore the expectation of your operation will take place before surgery (usually when initially seen in Outpatients) so that you understand the likely result, and the risks/benefits of the proposed operation. This information must be taken into account when you make the decision to undergo surgery.
This initial consultation may be with the Foot and Ankle Nurse Practitioner in the nurse-led foot clinic.

You will have the opportunity for further discussion about your surgery with the surgeon in the pre-admission clinic.

The Nurse Practitioner and nurses team will arrange or carry out pre-operative tests, usually blood tests, ECT, x-ray (if more are required), foot scan (Pedivarograph).

If you have any concerns please contact the Musculo Skeletal Outpatients Helpline. The number is identified at the last section of this information.

You will not be able to eat or drink for a period of time before your operation. The nursing staff will advise you on admission when you should stop eating and drinking in preparation for your surgery. You will be helped into a gown and the nurses will complete a checklist in order to ensure you are safely transferred to theatre. A member of nursing staff will escort you to theatre either on a trolley or bed. Once in theatre your care will be transferred to a member of the theatre staff who will check your personal details again and who will look after you until it is time for your anaesthetic.

Once in the anaesthetic room you will be given an injection in your hand to put you to sleep if you are having a general anaesthetic. If you are having a local anaesthetic block the anaesthetist will discuss this with you fully. The local anaesthetic block also provides a good form of pain relief after surgery.

The first 48 hours

After a short stay in the theatre recovery area you will return to the ward. When you come back from the operation your foot may be elevated on a pillow or frame. It is extremely important that your foot is kept elevated at all times, to prevent swelling, which could hinder your recovery.

You may also have a wool and crepe bandage or plaster cast on your foot. Depending on your surgery you may start getting up and about the next day. The physiotherapist will explain this to you, if required. Many patients find that they are more comfortable if they transfer their weight to their heels when walking (if weight bearing is indicated by the surgeon).

You will also have stitches in the wound and these are usually removed 10 - 14 days after the operation.

Many patients worry about how painful foot surgery will be and all staff understand this. It is usual to experience some discomfort and the staff will give you painkillers when you need them to help keep you comfortable. Everyone feels differently and it is important that you tell the nurses if you are in pain.

Getting up and about

You will usually be able to get up the day after surgery and you may require an x-ray. Your surgeon and Nurse Practitioner will decide exactly how much walking about you can do. The physiotherapist will show you how to heel weight bear and how to manage the stairs prior to your discharge.

If you have a plaster cast in place your surgeon will advise you regarding walking, you should have a copy of the plaster care leaflet. Please ask your named nurse for a copy, if required.

You may have wires in your toes. These ensure that your surgery heals in the ideal position. These wires will remain in place until you return to the Outpatient Department.

Your stay in hospital will usually vary depending on your progress. Once you are mobilising safely, heel walking or with crutches, you will be discharged home as soon as suitable arrangements can be made.

Planning for going home begins as soon as you arrive in hospital, if you have any fears or concerns regarding discharge please discuss these with your named nurse.

Your named nurse will ask you and your carers about your social circumstances, this is just to ensure that you will be able to manage certain tasks when you go home such as washing, dressing and cooking.

If your named nurse feels you and your carer will require extra support she will discuss this with you, and with your permission arrange for you to discuss your needs with the hospital Social Worker and Occupational Therapist.

Transport Home

Please discuss your transport arrangements home with your named nurse before your day of discharge. It is possible in some instances to organise hospital transport, if required.

The day of your discharge

On the day of your discharge your named nurse will give you some things to take home with you, these will include:

• A letter for your GP (in some instances this will be posted) This should be handed in to your GP by either a relative or friend on the next working day following your discharge.
• Medication Any medication you have brought into hospital will be returned to you. You will also be given a 7-day supply of any new medications. The nurse will advise you on how and when to take these.
• Dressings / Plaster Cast All dressings should be left undisturbed until you are seen in clinic when the nurse will remove your sutures. If your bandages become loose, or you have any concerns regarding your bandage, please contact Musculo Skeletal Outpatients Clinic or the France Clinic at Newcastle General Hospital, who will be happy to help.
• Outpatient Clinic Appointment you will be given an appointment to be reviewed in clinic. If transport is required then this can be arranged by contacting your GP, providing a week’s notice where possible. If for any reason you are unable to attend your appointment please contact the Outpatient Department to rearrange the appointment.
• Care Plan If you have a care package arranged you would receive a copy of the care plan from the social worker before your discharge home. This is for your own information.
• Discharge Record This provides details about your stay and is for your own information.
• Patient Information Please take home any written information given to you during your stay and please do not hesitate to use the contact numbers if you require any further advice.
• Valuables Please ensure you have all your valuables with you.

General advice after discharge

The period of convalescence you will require will depend on the nature of your surgery and your individual circumstances.

• Exercises Keep doing the exercises you have been shown to keep your other joints mobile. Your foot should remain elevated, when sitting, for at least 2 weeks following surgery, unless you are advised otherwise. If you experience any problems then please contact the ward or Outpatients Department.
• Work How soon you are able to return to work will depend on the type of job you do. You should discuss this with your consultant when you see him in the Outpatient Department.
• Wound care Keep your wound dry until your stitches have been removed. Your stitches will be removed when you attend the Outpatient Clinic. Once these have been removed, you can bath or shower, as you feel able.
• Pain Take your painkillers as prescribed. Do not take more than the stated dose. If you are experiencing increased pain in your foot, if you have any pain or swelling in your calf or if you have any chest pain please contact the ward or your GP for advice.
• Cars and driving It is inadvisable to drive whilst wearing a cast, splint or restrictive bandage. Always check with your insurance company before starting to drive again. 
  It is not the responsibility of your consultant to make this decision. He will advise when he feels driving will cause you no harm.

Return of equipment

Please return all walking aids to the Physiotherapy Department at the hospital in which you stayed, when they are no longer required. All other equipment should be returned to the loan equipment store it came from, ring them and they will collect it (the numbers are outlined at the back).

Follow up

You will be followed up as an outpatient at regular intervals after your discharge from hospital. Please use this opportunity to ask questions and discuss any concerns you may have. You are also welcome to call the ward or Nurse Practitioner for advice, following your discharge from hospital.

Contact Numbers

Below are some numbers you may find useful once you have been discharged, please do not hesitate to contact any number for additional help or advice, the staff would be happy to help you.

Outpatient Clinics
Fracture Clinic Newcastle General Hospital: (0191) 233 6161 Ext: 22813
Musculo-skeletal Outpatients Freeman Hospital: (0191) 2231109/0191 2231040 Direct Line

Wards
Newcastle General Hospital: (0191) 233 6161
Ward 20 Ext: 23520
Ward 21 Ext: 23521
Ward 35 Ext: 23535

Freeman Hospital: (0191) 233 6161
Ward 17 Ext: 37017
Ward 18 Ext: 37018
Ward 19 Ext: 37019
Ward 20 Ext: 37020

Other Contacts

Physiotherapists
Newcastle General Hospital: (0191) 233 6161. Ask the switchboard operator to Bleep 1899 or DECT Phone 29370
Freeman Hospital: (0191) 233 6161. Ask the switchboard to contact the Senior 1 Physiotherapist Orthopaedics.

Foot and Ankle Nurse Practitioners
Newcastle general Hospital: (0191) 233 6161. Ask the switchboard to Bleep 1517

Occupational Therapist
Newcastle General Hospital: (0191) 233 6161. Ask the switchboard operator for the Occupational Therapy Department and ask for the Orthopaedic Therapist.
Freeman Hospital: (0191) 233 6161. Ask the switchboard operator for the Occupational Therapy Department and ask for the Orthopaedic Therapist.

Social Worker
Contact the relevant hospital switchboard and ask to speak to the Social Worker.

Pharmacy Help Line
Newcastle General Hospital: (0191) 2824179 Monday to Friday 9.00 am – 5.00 pm.
Freeman Hospital: (0191) 223 1230 Monday to Friday 9.00 am - 5.00 pm.

Health Information Service (0800) 66 55 44.

Loan equipment
Newcastle - (0191) 219 4662
North Tyneside - (0191) 200 6184
South Tyneside - (0191) 454 0927
Northumberland - (01670) 730595
Gateshead - (0191) 402 6433 (ask for home loans)
Durham - (01388) 812 812