While an effective means of treating serious, debilitating conditions, foot surgery is not always the answer to alleviating pain. In fact, the risks inherent in invasive operations can sometimes outweigh benefits for people who have issues that can be treated conservatively.
Dr. Frank Santopietro has spent the past 30 years as a board-certified Podiatric surgeon, and this experience has informed his philosophy that foot surgery should always be a patient’s last resort. Operations have come a long way in recent years – they’re safer and more effective now than ever – but so have conservative means of treatment. Dr. Santopietro believes that exploring these non-surgical options is a necessary step prior to surgery.
Before going under the knife, patients should consider that the operation could take them off their feet for about 1 week to 3 months, depending on the procedure. That means time off from work and having to make special accommodations such as:
- Casting for bone procedures
- Arranging transportation as post op patients cannot drive for a period of time.
- Non – weight bearing for up to 3 months
- Possible post op complications such as infection, delayed healing, thrombophlebitis and /or recurrence of problem.
- If you are a runner – do not plan any runs for 3 to 6 months from the time of surgery.
Conservative means of treating foot pain include use of custom orthotics, casting or even just simple rest. If these solutions don’t produce results over a certain period of time, surgery may be necessary. In these cases, a patient should expect to: •
- Schedule a number visits with Dr. Santopietro to attempt conservative treatment, before considering an operation.
- If a surgery is performed, you would have weekly follow-ups for 2 to 4 weeks.
- Long term follow-up will occur regularly in the months following surgery.
Surgery FAQ:
We understand that many people are at the very least curious about surgery and what it would mean for them to get surgery. We feel there are many misconceptions about the surgical process however and wish to answer any questions about the process.
How long does recovery from surgery take? How long will I have to stay off my feet? How long will it take to heal? When can I go back to walking/ being active?
Recovery depends on the procedure performed. When an osteotomy (bone is broken on purpose in the course of the surgery) is performed recovery can take up to 6 months. Some procedures require non-weight bearing for one week, others for 2 to 3 months. A relatively simple bunionectomy with distal osteotomy requires being off ones feet for 10-14 days and then in a removable cast for up to eight weeks. Any procedure that breaks a bone and then requires the bones to regrow and attach to each other requires at least 6 to 8 weeks to heal and more time to fully return to normal weight bearing activity (10-12 weeks to prevent fracture of new bone). Simple osteotomies require about 2 weeks in a cast, completely non-weight bearing, followed by 2 months in a walking cast and finally a transition to full time sneakers (meaning no barefoot or other types of shoes worn) for another 2 months. So, total time to return to activity with simple bunion with osteotomy is about 4 months. Simple bunionectomy without osteotomy is about eight weeks.
Can I swim after my surgery or even get my surgical site wet?
Yes, the wound can get wet after stitches are removed or the incision is stable, in approximately one to three weeks. Swimming, however, is often discouraged until the bone is stable.
Can I ride a bike after surgery? How many weeks before I can bear weight, pedal etc?
Stationary bike riding can be done with removable cast soon after surgery – approximately two to three weeks . However regular bike riding SHOULD NOT be attempted.
Will I be prescribed medication before, during, or after my surgery? If so what types of medication are possibly prescribed? What are their side effects, if any?
Medications post operatively are prescribed for pain and sometimes are not tolerated well. A long acting local anesthetic is injected at the end of the surgery which can last up to 12 hours, which is the most painful period. Ice and elevation also help to control pain.
What should I expect at the surgical center?
The surgery center is an outpatient facility that generally is a pleasant experience. One arrives an hour or so before surgery and is guided through the process. The staff at the surgery center are very well trained and experienced professionals and will take very good care of you and your family before, during and after your operation.
Will Dr. Santopietro use local anesthesia or general anesthesia?
Usually local anesthesia is used after an initial short acting general anesthesia to eliminate the discomfort of the local anetsthesia. Once local anesthesis is achieved the general anesthetic is reduced. For more complicated surgery general anesthesia would be necessary.
What other doctors / staff (if any) will be present during my surgery?
Typically we will have an anesthesiologist on hand to administer the anesthetic. Additionally a surgical assistant will be present and occasionally a resident in foot surgery may be present.
What are the expected side effects of surgical therapy, if any?
Side effects of surgery are present and are one reason we discourage jumping right into a surgical solution. Very rarely, a problem will not be resolved by the surgical treatment. Sometimes a decrease in range of motion of joint will result, and sometimes a delay in the healing or infection can occur. Additionally, as with any surgery, there can be complications of general anesthesia – these are rare, but can occur.
What are some of Dr. Santopietro’s reservations about doing surgery in general?
My reservations with surgery are that in general most problems can be resolved conservatively with well-constructed and custom foot orthoses, and well-fitting shoes. These tend to eliminate the need for painful and costly surgery. Surgery is a last resort and any patient that we operate on needs to have orthoses before having surgery. People recover faster post-operatively when they wear orthoses. Additionally, at EvenKeel Podiatry, we do not do purely cosmetic surgery. There must be a functional problem that will be resolved with surgery; this can also improve the cosmetics, but this would be a beneficial side effect.