Part 1: Before Surgery

Use this three-part guide to help make your orthopaedic foot or ankle surgery and recovery go smoothly. You achieve the best results when you work with your foot and ankle orthopaedic surgeon to prepare for surgery and post-surgical recovery. Part 1 will focus on what to do before your surgery.

How do I prepare myself for surgery?

Make a list of questions and discuss them withe your surgical team at your pre-operative visit. You should understand what your surgery will entail as well as the expectations after surgery. Bring a complete list of your medical conditions and medications (including prescription, over-the-counter, and herbal/nutritional supplements) with the dosage for each one.

Will I need medical testing before surgery?

Your health conditions and your planned surgery may require that you undergo testing before surgery. Testing may include blood work, X-rays, EKGs and in some cases medical clearance by your primary care provider or specialists such as a cardiologist.

Do certain medications need to be stopped before and/or after surgery? If so, which ones?

Some medicines can be dangerous when taken just before or after surgery. Your surgeon will tell you which medicines must be stopped before or after surgery. Your surgeon may tell you to stop taking:

  • Aspirin before surgery. This drug can increase bleeding during surgery.

  • Non-steroidal anti-inflammatory drugs (NSAIDs) including ibuprofen (Advil and Motrin), naproxen (Aleve), Celebrex, and Mobic. These drugs can increase bleeding during surgery by decreasing one's ability to clot blood. They may also slow down bone healing after surgery.

  • Certain steroids as they may slow down wound and/or bone healing after surgery.

  • Hormone replacement therapy and/or birth control pills after surgery. These may increase the risk of having blood clots after surgery.

  • Metformin or diabetic medications related to metformin at least 24 hours before surgery. These medications can cause a reaction to anesthesia.

  • Certain over-the-counter (OTC) supplements and/or herbal preparations (fish oil, St. John's Wort, etc.) before surgery. Many of these agents can increase bleeding during surgery.

Does the use of nicotine affect surgery?

Nicotine and other chemicals are contained in cigarettes, electronic cigarettes, cigars, and chewing tobacco. Nicotine slows down the flow of blood to and from the surgical foot and ankle. This effect of nicotine can increase the risk of developing bone, soft tissue and wound healing problems and/or infections after surgery. Slowing down the blood flow in one’s leg may also increase the chance of getting a blood clot or deep vein thrombosis (DVT). To get the best results from orthopaedic foot and ankle surgery, you should stop using nicotine-containing products well before surgery. You should discuss quitting with your surgeon and/or primary doctor.

What devices do I need to get to use after surgery?

After orthopaedic foot or ankle surgery, you will not be allowed to put weight on your operated leg for a period of time. To avoid putting weight on your surgical foot or ankle, you will need to use an assistive device like crutches, a walker, a knee walker, or a wheelchair.

Other devices/equipment may be considered to help in performing daily activities in the home, including a bedside commode, shower chair/stool, or transfer board (especially if you are non-weightbearing on both legs). Many of these devices may be covered by your insurance company.

Is physical therapy (PT) needed before surgery?

To walk smoothly and safely with an assistive device, you may need to receive training from a physical therapist. The surgeon may schedule a PT session for you before surgery to get you familiar with assistive devices, fit the assistive device if needed, and improve balance, arm strength, and opposite leg strength.

When should I stop eating and drinking?

Typically, you will be instructed to not eat or drink after 11:59 pm on the night before your surgery. This means no coffee, chewing gum, or water in the morning. If your surgery is later in the day, you may be allowed to drink clear liquids until about 6-8 hours before your surgery.

Why is this important? You should have as little food, drink, or stomach acid in your stomach as possible at the time of anesthesia. After eating or drinking, it takes at least 6-8 hours for food and/or drink to leave the stomach and enter the intestines. If you do not eat or drink after 11:59 pm on the night before your surgery, your stomach should be empty by the time anesthesia is administered. This decreases the chances of nausea, vomiting, or an upset stomach with anesthesia. It also decreases the risk of aspirating stomach contents into your lungs, which is uncommon but can be a serious complication.

If you take certain medicines regularly in the morning, exceptions may be made to allow you to take the medication with small sips of water on the morning of surgery. Review your medications with your surgeon and anesthesiologist before surgery.

Next: Part 2 – The Day of Your Surgery


Original article by Jamal Ahmad, MD
Contributors/Reviewers: Eric Bluman, MD, PhD; Naomi Shields, MD; Stephen Pinney, MD

The American Orthopaedic Foot & Ankle Society (AOFAS) offers information on this site as an educational service. The content of FootCareMD, including text, images, and graphics, is for informational purposes only. The content is not intended to substitute for professional medical advice, diagnoses or treatments. If you need medical advice, use the "Find a Surgeon" search to locate a foot and ankle orthopaedic surgeon in your area.