ANKLE & FOOT
by Eric J. Buchbaum, DPM
Although foot surgery is effective at correcting underlying bone deformities; Patients sometimes find the postoperative recovery frustrating when it involves periods of non-weightbearing in a cast or walking boot. In an effort to improve postoperative symptoms and enhance quality of life; recent research has focused on early weight-bearing with studies supporting that new protocols can improve short-term symptoms and outcomes.
Depending on the surgery, early weight-bearing in patients who have stable fixations with osteotomy surgeries (cutting and repositioning bone) can be a viable postoperative treatment option since it can help to reduce swelling (directly correlated with pain) and hasten recovery.
Data has shown that early weight-bearing can reduce symptoms without affecting union rates (bone healing) or complications during postoperative recovery. Patients who participate in early weightbearing are also potentially more comfortable during postoperative recovery than those who are in a cast for a longer period of time.
In 2010, a study in the Journal of Foot and Ankle Surgery was the first to demonstrate that early partial weightbearing approximately two weeks after a bunion surgery did not compromise outcomes. The duration of time to bone healing was similar to rates reported in previous studies describing procedures with longer durations of initial postoperative non weight-bearing. There were no complications requiring surgical revision and no hardware was broken before solid bony fusion occurred in the study group.
With advances in more stable surgical technologies, such as locking plates and screws, early weightbearing after bone procedures is possible without compromising hardware. In addition, this recovery may also reduce risks associated with prolonged non-weightbearing including blood clots, joint stiffness, muscle weakening, and osteopenia.
Decisions about whether to recommend early weightbearing after foot surgery depend on the severity of the deformity, the type of surgery and fixation used, as well as individual patient characteristics. Age and medical comorbidities play an important role in a patient’s ability to heal from bone surgery. Patients with peripheral neuropathy, obesity and osteoporosis are poor candidates for early mobilization. It is well known in the literature that smokers are more likely to develop bone healing complications and account for a majority of non-unions.
Bathing of the area and removal of the surgical bandaging can typically occur after one week. Depending on the procedure performed, I emphasize nonweightbearing for two weeks postoperatively until the incision has completely healed. I then allow partial weight bearing in a removable short leg boot if tolerated. Increases in weightbearing are progressed on a weekly basis and are guided by swelling and pain. In addition to patient symptoms; clinical and radiographic evaluation helps dictate the transitions from non-weightbearing to weightbearing to a return to athletic shoes and full activities. This becomes of particular interest to those patients who undergo surgery on the right foot as the return to an athletic shoe allows a return to driving.
Every patient requires a customized plan to best suit their post-operative recovery but it has been exciting to see advancements in both hardware and post-operative management as it has greatly affected patient outcomes and an early return to function.