Wound Care

• Dressings: After surgery you will be in a padded splint with dressings.
• You are to maintain dressings completely dry until the first post-operative visit. At that time, dressings will be removed. This ensures the surgery is protected/remains sterile until return to the office. Failure to maintain dressings may compromise surgical outcome.
• Do not attempt to move your toes, foot or ankle in the dressings until discussed with Dr. Pettit at the next appointment. The dressings are meant to maintain the leg in an appropriate position. Failure to maintain immobilization may compromise the dressings and therefore alignment and surgery outcome.
• You may require a boot after surgery and we will assist you with this in the office. If you plan on not obtaining a boot at your first post-operative visit or already have one, please bring your boot to your first post-op appointment. Failure to do so may require another boot purchase at this first appointment and compromise outcomes. You will not be allowed to return home unprotected and put your boot on later.

Weightbearing

• After surgery you may not put any weight on your lower extremity unless instructed by Dr. Pettit. Progression to weightbearing will be discussed at your first post-op appointment. Please make arrangements at home for assistance with these instructions. Falling after surgery can be common in any age group and may compromise your surgical outcome. Maneuvering around home, stairs, etc. need to be planned for PRIOR to surgery.
• While recovering from surgery, you will need to use one of the following assist devices in order to get around: crutches, knee roller, walker. When using crutches, use both in order to walk. If you are given a post-operative shoe after surgery you need to leave this on at all times until returning to the office.
• Elevation: After surgery you must rest. Elevate your operative foot/ankle to the level of your heart at all times until your return to the office unless going to the bathroom. Maintain elevation as much as possible. Avoid any unnecessary activities until your first post-operative visit. This limits swelling in the extremity, helps wound healing, and limits pain. Failure to follow these instructions may compromise the surgical outcome, including infection.

Pain Control and Medications

You have been given a regional anesthetic block prior to your operation. This will wear off in the evening following your surgery.

1. Pain Medication: Tylenol 1000mg every 8 hours and, unless discussed otherwise, you have been prescribed a narcotic pain medication (Oxycodone 5mg) to take every 4-6 hours as needed.
• DO NOT drive/use any heavy machinery, drink alcohol, make any life-changing or legal decisions (i.e. sign a will), or participate in activities that require a lot of physical skill, as narcotics may change your mental acuity. On rare occasions they may cause confusion or disorientation, we advise you to discontinue this medication should that occur.
• Narcotics can be addictive. Dispose of any excess medication at a police/fire station.
• Take a stool softener (e.g. Colace) while taking narcotic medication, as narcotics may cause constipation.  If this does not help alleviate your constipation, you can try adding miralax or milk of magnesia. Please call our office if this regimen does not alleviate your constipation.
• If you have any questions or concerns about narcotic strength medications, please contact us.
• Journavx (suzetrigine): If Journavx has been prescribed, take it in place of the Oxycodone. Start with a loading dose of 100 mg (two 50 mg tablets), then take one 50 mg tablet twice a day (every 12 hours) for two weeks. If you are not getting adequate pain control with Journavx, you may take Oxycodone instead. Do not take Journavx and Oxycodone at the same time, and avoid grapefruit while taking Journavx.
2. Anti-nausea: Zofran (Ondansetron): Take as prescribed if needed for nausea
3. Anti-Inflammatory: Unless contraindicated due to other health reasons, you have been prescribed a non-steroidal anti-inflammatory drug (Ibuprofen 800mg) for use postoperatively. If you have no personal history of adverse response to anti-inflammatories (NSAIDs), take as prescribed every 8 hours with food to help reduce swelling and pain. Do not take other NSAIDs (Advil, Aleve, etc) with Ibuprofen.
4. DVT prophylaxis: Please take one 325mg Aspirin daily for 30 days following surgery to help minimize the risk of blood clot (extremely rare). If you are under age 16, unable to take aspirin for other medical reasons, or are currently on anticoagulation, you do not need to take aspirin after surgery.
5. Muscle relaxer: Flexeril (Cyclobenzaprine) for muscle spasms. Take this as needed, it will make you drowsy.

Tylenol and Ibuprofen are the foundation for your pain control regimen

Example dosing: 1000mg Tylenol then 4 hours later 800mg Ibuprofen then 4 hours later repeat- every 4 hours alternate between Tylenol and Ibuprofen. Oxycodone as needed for breakthrough pain.

*You should not exceed 3,000mg of Tylenol or 3,200mg of Ibuprofen in 24 hours.

Bathing, skin care:

• Do not take a bath, swim, sit in hot tub, or otherwise submerge your operative leg for 6 weeks after surgery unless otherwise directed. If scabs still exist on your wound do not submerge until cleared with Dr. Pettit. b. Generally, after 2 weeks you may begin to get the foot/ankle wet by letting water flow over the leg. Dr. Pettit will confirm this in the office and the leg should not be placed in shower until this discussion. If you have pins outside the skin, keep the foot dry at all times until the pins are removed in the office.
• Do not place any lotions, ointments, cleaning solutions, Vitamin E, or any other topical items on the leg after surgery unless instructed. These may compromise the surgical outcome.

Physical therapy:

• If your procedure requires therapy, a prescription will be given to you at one of the office visits after surgery. Some surgeries do not require physical therapy and some require immobilization for weeks before starting therapy. This is normal and failure to maintain immobilization before discussed may compromise the outcome of surgery.

Travel:

• You will be restricted from traveling by air after surgery until you begin the weight bearing process. Failure to comply with this may result in blood clots causing medical and surgical complications. No prolonged car rides over 2 hours without stopping to stretch for at least 5 minutes. Please discuss any potential future travel plans with Dr. Pettit as changes to your treatment may be required.

Driving:

• You are not to drive until seen in the office for your first post-operative visit.
• By law, you may not drive while you are still taking narcotic pain medication.
• If you have surgery on your right foot, you will have a post-operative shoe or boot as part of post-operative instructions. You may not drive until these are able to be removed as directed by Dr. Pettit.
• If your left lower extremity has been operated on, you are welcome to drive a vehicle that has an automatic transmission (not a manual/stick shift) if elevation requirements are met, you are no longer taking narcotic pain medication, and feel comfortable driving in all situations.
• Make plans for alternatives to driving during these weeks in a post-operative shoe/orthotic/brace.
• When returning to driving, we recommend practicing in a deserted parking lot or safe area. You should not resume street driving until you feel able to make a concerted emergency stop and feel comfortable with vehicle control.

Follow-up Appointment:

• Your first post-operative appointment will be scheduled 10-14 days following your surgical procedure. Typically dissolvable sutures are used during surgery, and do not need to be removed. If you do have sutures that need to be removed, this will occur at your first post-operative visit. If you do not have a post-operative appointment scheduled when you leave following surgery, please call 513-441-5639 to make the appointment.

****Signs & Symptoms to Immediately Report****

Call 911 and go to the nearest hospital if you are having chest pain or trouble breathing.