Surgery FAQs
The information below is intended to be used as a general guide and does not apply to each unique patient and surgery. If you have a personal question/concern, reach out to our office at the numbers listed below. Raleigh Orthopedic always has a provider on-call to support with any post-operative questions/concerns.
Monday - Friday | 8AM - 5PM 919.781.5600 (extension 5613)
After Hours/Week Day or Weekends | 4PM - 8AM 919.719.3079
Pain Management
What pain medication will I be prescribed? For most surgeries, patients are prescribed Oxycodone (5mg). This medication is intended to be taken every 4 - 6 hours as needed. This medication does not need to be taken if pain is manageable. The goal is to space doses out for as long as tolerable. As pain improves, patients can consider taking half a tablet instead of a whole 5mg pill. If you know you would like something less strong than the Oxycodone, please discuss it with Dr. Casale prior to surgery.
How long will I need to take pain medication for after surgery? This varies based on individual needs as well as surgery performed. Generally, patients are able to wean off opiate pain medications within a week of surgery. The goal is to manage pain exclusively with acetaminophen (Tylenol) as soon as reasonably possible. Some pain, even with pain medication, is normal and expected after surgery. It is not uncommon for patients to take acetaminophen (Tylenol) as needed for several weeks after surgery.
When should I start taking prescription pain medication after surgery? If you did not have a nerve block, you should begin taking pain once you get home. If you did have a nerve block, you should take a dose of pain medication once you feel the sensation begin to return in your leg/foot or when you notice that you can start to wiggle your toes. It is ideal to have a dose of pain medication in your system as the block wears off, as the pain can initially be severe. It takes about 20-30 minutes for the prescription pain medication to take effect.
When should I stop taking prescription pain medication after surgery? As pain becomes more tolerable, I encourage patients to begin spacing out doses or consider taking half a tablet (instead of a 5mg pill). Substituting doses of acetaminophen (Tylenol) instead of prescription medication should be attempted as pain improves. The goal for most patients is to discontinue prescription medications a week after surgery and using over the counter analgesics with tolerable pain.
What are the side effects of the prescription pain medication? Common side effects include constipation (take a stool softener, such as Colace, when you are on the pain medication), nausea/vomiting, GI upset, drowsiness/tiredness, dizziness, headaches, confusion, and itchiness. Do not drive or operate any heavy machinery when taking pain medication.
Can/should I take Ibuprofen (Advil) or Naproxen (Aleve) after surgery? These medications should be used sparingly as they can lead to GI upset or ulcers/bleeding. They can also have a detrimental effect on bone healing.
Nerve Block and Expected Numbness
How long does the nerve block last after surgery? The nerve block typically lasts 24-36 hours. However, it is not uncommon to have some residual numbness in the foot/toes for several days.
Is it normal for my foot/toes to be numb after surgery? Yes. See above for more information about how long the nerve block will last. Even after the nerve block has worn off (or even if you did not have a nerve block), it is common to have some numbness in the foot and toes for days, sometimes weeks, after surgery. This typically resolves once the swelling decreases, the initial splint/dressing is removed, and range of motion/weight bearing is initiated.
Why does my foot/toes feel numb after surgery even though the nerve block has worn off? The most common reasons for persistent for numbness/tingling after surgery are a) swelling of the limb, which can put pressure on nerves on the limb and b) immobilization/lack of use.
Discoloration of Skin
Is it normal for my foot/toes to be discolored and/or swollen after surgery? Yes. Swelling and discoloration (darker color) is to be expected. The cause is increased blood flow to the operative limb after surgery and decreased venous return. Keeping the limb elevated above the level of the heart is the best way to address this. It may take several months for this to completely resolve.
Why is my foot/leg orange or brown? This is due to the surgical prep that was used. It will eventually come off after you are cleared to bathe.
Infection
Do I need antibiotics before or after surgery? In most circumstances, you are given a dose of antibiotics through your IV before your surgery begins. In general, there is no need for antibiotics after surgery (note: some exceptions exist, such as if your surgery was completed to aid with an infection)
How will I know if there is an infection? It is unusual (though not impossible) to have a post-op infection in the first 2 weeks after surgery. The dressing/splint was placed sterilely in the operating room. If you have any increase in pain or swelling (especially >1 week after surgery), or any fever/chills, please contact our office immediately.
Post-Op Shoe and Boot Best Practices
Can I take off my post-op shoe or boot at night? Yes - if you were placed in either a post-operative shoe or a boot after surgery, this can be removed at night when sleeping. Remember to keep the limb elevated about the level of your heart while sleeping.
If my dressing/splint feels too tight, can it be changed? Yes. It is not uncommon for this to occur as there will be swelling after surgery. Swelling is highly dependent on the position of the limb - so keeping the limb elevated consistently will decrease the amount of swelling. If elevation of the limb does not help with the tightness of the dressing/splint, please contact us at the above numbers and we will change the splint/dressing in the office.
If my dressing/splint comes loose, can it be changed? Yes, please contact us at the above numbers and we will change the splint/dressing in the office.
Do I need to keep my dressing/splint dry? Yes. In most circumstances, the dressing or splint will stay on until your first post-op visit. It will need to be kept clean and dry. The easiest way to accomplish this is to purchase a “cast cover” from your local pharmacy or on Amazon. (LINK). You can also take a sponge bath.
Daily Living
When can I drive after surgery? If your surgery was on your left foot, you can drive an automatic transmission car once you are completely off of the pain medication. However, keeping your foot in a dependent (i.e. not elevated) position will lead to increased swelling and pain, so try to limit your driving as much as possible. If your surgery was on your right foot, and you were placed into a post-operative shoe and allowed to bear weight after surgery, you can drive once the nerve block has completely worn off and you are completely off the pain medication. In most other circumstances, it will be at least several weeks - possibly months - until you are cleared to drive. Please discuss with Dr. Casale at your post-op visit.
When can I get a pedicure after surgery? In most circumstances, we recommend waiting at least 6 weeks after surgery before getting a pedicure. This includes painting your toenails at home.
When can I shower/bathe? In most circumstances, you will need to keep your dressing/splint clean and dry until your first post-op visit. Once the sutures are removed, you will be cleared to shower once the sutures are removed at your first post-op visit. However, please do not soak the foot in a bathtub/pool until at least 6 weeks post-op.
When can I fly after surgery? This is highly variable. Flying close to surgery increases your risk of a blood clot. Please discuss directly with Dr. Casale if you have plans to fly within 3 months of surgery.
Do I need physical therapy after surgery? When do I start physical therapy? In most circumstances, if physical therapy is necessary, this will be arranged at either your first or second post-op visit. In the first 2 weeks following surgery, rest and keeping the limb elevated is the best thing you can do. You can wiggle your toes as often as you would like.