One of the most important aspects of my job as a podiatrist is to help guide patients through a decision making process regarding their surgical care. And one of the most important aspects of that decision is how long we can anticipate it will take for the surgery to heal. This decision will have an impact on return to work, social activities, family care and a host of other issues specific to that particular patient’s life. First, let’s take a look at preoperative considerations.
The first consideration is the patient’s general health status. Is this patient able to go through this surgery successfully? Do they have the capacity to heal? Considerations such as age and comorbidities need to be reviewed. Co-morbities are the conditions that may affect healing and include arterial or venous disease, diabetes, obesity, heart disease, etc. As comorbidities become more numerous and complex, the chances of a good outcome from foot surgery obviously decrease. The most important tool to judge the impact of these comorbidities is a good history and physical exam.
Next, does the patient have the support team at home to complete the surgery? Are they a widow living on their own or are the a member of a family with a spouse and adolescent children? Does the patient have an infant at home who will need care? In each scenario, advanced planning is necessary to insure a good outcome from foot surgery.
What is the nature of the surgery? I find it interesting that some foot surgery has significantly more disability than a total hip or knee replacement! For instance, a total hip or knee replacement will be ambulatory within the first few days of surgery. A fusion of the foot or ankle will require 8-12 weeks of non-weight bearing. That’s a long time to be on crutches. Pre-op counseling is imperative to be sure that patient’s recognize the degree of disability associated with their surgery.
OK, let’s fast forward to the question at hand; how long is it going to take to heal following foot surgery? As a general rule, soft tissue surgery (cysts, nerve releases) will heal in a 2-4 week period. Sutures are typically in for a 14 day period. Many soft tissue procedures are what we call ambulatory meaning that the patient can walk beginning the day of surgery. Granted, you may not want to walk very far, but at least you’ll be able to bear weight on the foot.
Bone procedures will take longer to heal. Most bone procedures will require an 8 week period of healing before they become structurally capable of being able to bear load (body weight). This time period does vary widely based upon the nature of the procedure and surgeon preferences. Some bone procedures, such as a bunionectomy can be performed in a manner in which load can be applied to the foot immediately post-op. But other procedures such as a triple arthrodesis will require 10 weeks non-weight bearing.
Part of the impetus for this post was a patient I saw yesterday (picture at left). This patient is 10 weeks post dorsiflectory osteotomy of the 1st metatarsal and a wedge osteotomy of the heel called a Dwyer procedure, right foot. In the picture you can see how the patient’s right foot (surgery foot) is red while the left foot is white. This is an excellent example of what’s called reflux hyperemia. Reflux hyperemia is the vascular response of the foot to both the surgery and 8 week period of casting. The take home point here is that even though we speak of healing being 8-12 weeks for a bony procedure, the body is still attempting to understand how to manage this injury we call surgery. And yes, we really can describe surgery as a controlled injury.
So how long does it really take to heal? I tell my patients that the first 75% of healing takes place within the first 2 months post-op. The remaining 25% of healing takes upwards of a year. This last 25% is a reorganization period where post-op scar tissue is reorganized and essentially, your body optimizes the surgical injury so that it can ultimately function at 100%. And the example above (reflux hyperemia) is just one of the many issues your body manages in that later 25% of healing.
If you have an interest in a specific condition and how that condition will heal following surgery, be sure to check out our knowledge base on Myfootshop.com. The majority of the conditions in the knowledge base describe how they can be treated surgically and describe an estimated time frame for healing.
Jeffrey Oster, DPM