Bunion surgery recovery: comprehensive week by week post-operative instructions with videos
Before anyone proceeds with a surgery of any kind, they want to know what recovery look like? When can I walk, how often do I ice, do I need to elevate, what pain meds should I take…etc. This blog serves as a guide to Dr. Paul Steinke’s existing and potential patients only. If you have Lapiplasty® bunion correction with another surgeon, discuss with your surgeon any questions that you have the day of your appointment, and after surgery make sure to call with any questions or concerns that arise.
For in depth instruction on how to perform task, click the links to blogs on icing, elevation etc.
So lets begin. The surgery is complete, now what?
First 24 hours after surgery instructions
Head home in your walking boot, only apply pressure to foot flat footed with the assistance of a walker or crutches when in the home for short distances or transitions from bed to scooter, or getting on and off the commode.
When outside of the home make sure to use a knee scooter for long distance travel, which can be purchased online, or rented from a local vendor.
Putting pressure on the foot in the walking boot will be reserved when going to the restroom, or kitchen to quickly get a bite to eat, otherwise you will be resting on the couch or bed or recliner with surgical foot elevated. When resting, the boot can be removed, but if sleeping it is recommended to wear for protection from the weight of bedsheets, and when walking or using a knee scooter boot application is a must. Missteps or falls can happen, and the boot needs to be on to protect you from injury when moving around the home.
Now Rest! Sit down in a comfortable reclining chair, the couch or on the bed. Your foot needs to be elevated; this means your foot has to be higher that your knee. This helps avoid excessive swelling caused by surgery and prevents gravity from making your foot swell excessively. In bed, elevate the foot with one or two pillows, a wedge pillow is acceptable as well.
Take your medication as advised on the bottle. If your doctor has advised you to take an adjunctive medication like that is an anti-inflammatory alternate it with the narcotic medication with a snack. Nerve pain medications like gabapentin may also be prescribed and should be taken according to instructions on the prescription bottle. Taking medications with a small snack helps reduce risk of stomach upset, and also helps reduce pain by utilizing when the concentration of your primary medication wanes between doses.
Ice the foot directly behind the knee or to the ankle, or both simultaneously. Gel packs are great and reduce the risk of thermal injury to the skin as they cool down, just make sure you have a barrier(cloth) between the ice pack and the skin. I recommend applying ice pack for 30 minutes and then leaving off for 30 minutes the first day while awake. One icing session in the middle of the night is fine to ice and take a pain pill at this time with a snack.
Day two after surgery until first follow-up appointment instructions(days 2 and 3 after surgery)
Continue weightbearing instruction from day 1, these instructions will be followed for first two weeks(see video above).
Icing can be reduced to 4-5 times a day, 30 minutes each application and elevate foot.
Wiggle your toe twice daily gently for about two minutes, to prevent scar tissue(adhesions) from stiffening great toe. Your toe will not move dramatically but every little bit helps.
Leave dressing intact and take your pain medication as prescribed by your physician. You can adjust your ace bandage and reapply only if it has become uncomfortable and tight, but make sure you reapply in same way. Take a picture with your phone before you remove ACE bandage to remind you how to properly replace.
When bathing, use the supplied cast protector. Since you are not very active, for the first three days is not all that important to bath since your activity will be reduced and letting the leg down to bath while seated in shower can cause increased swelling and pain.
If pain is minimal after 24 hours, it is not recommended you cease narcotic medication just yet, but instead, lengthen time between doses. If you have been prescribed any nerve or anti-inflammatory medications continue taking them as directed. Doses of narcotic can be replaced with Tylenol if your pain is minimal, just don’t take Tylenol with narcotic tablet, as the narcotic tablet will already have Tylenol formulated into the tablet.
First post-operative appointment (day 3) instructions day 3 until 2 weeks
This appointment you will have x-rays taken, the physician will change your dressing, and discuss any concerns you may have.
Until your two-week follow-up appointment, instructions will remain the same, except you can more effectively ice your foot by applying ice directly to operative site because the new dressing will be much thinner, icing 4-5 times a day.
Rarely is renewal prescription for narcotic medication needed if you are following instruction properly.
Bathing is done after removing your boot after carefully sitting on a stool or ledge in tub or shower. A cast protector bag is placed over the dressing. If your foot becomes wet, please call the office immediately to help you to change dressing or come into office to have changed. Ignoring a wet dressing could lead to poor incision healing, infection or skin irritation.
Second post-operative appointment (day 14) Instructions for week 2 to week 4
This is the last day you will typically be in a dressing. If you have sutures to remove, they will be taken out this day. If you had a cosmetic closure this appointment will just be a check of healing to skin. Your dressing will be removed and replaced with a nylon ankle sleeve, that you will apply first thing in morning, to prevent excessive swelling and help reduce pain and improve healing. Please remove nylon sleeve at night.
Icing will continue at least once daily but preferably twice.
A pad called a toe spreader may be dispensed in the office to keep your operative toe nice and straight during recovery, and worn only during the day. A bunion splint may also be recommended for use at night when sleeping to gently maintain the straight position of the toe. The nylon sleeve and toe spreader do not need to be worn while sleeping.
To produce a beautiful incision result, scar cream or gel sheets will be recommended for daily application.
To prevent stiffness physical therapy will be prescribed as well as home exercises. Therapy is typically 2-3 times a week for 4-6 weeks. Not all patients need therapy.
I like to advise patients to make life easy by splitting their post-operative bunion care responsibilities into two sessions each day, one in morning and one in evening.
1) Perform Range of motions exercises to toe, as recommended by physical therapy
2) Apply scar cream
3) Ice 30 minutes
After two weeks walking is still recommended to be limited to the home and in your boot, walking flatfooted, but as each week progresses, more and more pressure can be applied to tolerance. By three to four weeks after surgery use of crutches is usually discontinued completely, and are no longer needed to assist walking.
If you need to drive and your surgery was to the right foot, a post-operative flat soled shoe may be provided. Note, this is only to be used for driving, and for short distances only. Your provider may not allow this due to your specific circumstances or if other surgical procedures were performed on your surgery day in addition to Lapiplasty have been performed and prohibit driving.
The most exciting development is that you can now get your foot wet in the shower, but do not take a bathe, showers only are allowed until skin is completely healed. Continue to sit until at least three weeks after surgery and if you opt to stand put pressure on heel and reapply your boot in seated position in the shower before you exit shower/tub.
Instructions weeks 4-6
No appointment at 4 weeks but a major change in your activity occurs. You can now start full weightbearing in the walking boot as tolerated walking heel to toe, instead of more flatfooted like the first 4 weeks. This is the first time that you will be walking in a normal gait pattern, but still in walking boot. This is to prepare you to discontinue your boot at week 6 appointment.
Third Post-operative appointment week 6 (instructions for week 6 to 12 after surgery
At your 6 week appointment, an X-ray will be taken to confirm healing and you will be transitioned into an athletic shoe with an insert, or preferably an orthotic that was made prior to surgery. This is designed to support the fusion site in the arch as it heals.
A good analogy to understand the importance of arch support/orthotic during recovery, is to think about a bridge under repair that is the only bridge into town. You wouldn’t shut the bridge down, you would just add support to ii while it is being repaired and kept it in use.
A new previously unworn shoe is recommended as the old foot structure will have changed older more worn shoes. A possibly a half size larger shoe may be required temporarily due to swelling.
Continued icing, scar cream application, range of motion of great toe, and nylon ankle support is recommended.
It is recommended to wait until after the 6-week appointment to perform cardio exercises, but when it begins it needs to be limited to nonimpact exercise like core work, weight machines that don’t apply pressure to sole of foot, rowing machines, recumbent and stationary bikes and swimming. No elliptical, stair steppers or classes at the gym since they are impact activities. Casual walking is allowed.
All activities are at reduced intensity and duration compared to prior to surgery and if pain is noted you should stop immediately. If you really need your exercise before 6 weeks a more comprehensive blog is here on when you can start and what exercises are allowed throughout recovery.
12 week appointment and beyond
At 12 weeks, an X-ray will be taken and instructions on how to return to impact exercise will be given. Exercise that involves impact like running, elliptical, heavy weightlifting, and sports will be allowed at 4 months after surgery. Again, of course slow return to exercise at decreased intensity and duration will be required and don’t exercise through pain, that is not normal to have increasing pain with activity.
Full recovery will be 6 months to a year. This does not mean that you will laid up the whole time or will have to drag your leg behind you like Igor, it only means that you will have occasional discomfort, swelling, and pain based on activity level.
Remember, everyone’s recovery differs, and Dr. Steinke may cater a plan to your recovery based on your health, severity of deformity, overall medical health, and how you are recovering. These instructions serve merely as a preliminary guide of expectations for you, please discuss any questions or concerns with Dr. Steinke throughout your recovery.
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