Post- Surgery Pain

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One of the most common questions I'm asked when a patient and I start discussing surgery as an option for their foot problem is, "How much will it hurt?"
 
This is always a tough questions to answer, since every individual has their own pain scale, and handles discomfort differently. The accepted pain scale pictured here              
                                                                                   
 
 
is only useful to compare different days or times for the same patient. One person's 4 is another's 9. Once I know what constitutes a 5 for a particular patient, I have a better sense of what they're telling me if they come back for their follow up visit and say they're at a 2. But I never assume your scale is the same as anyone else's.
 
Now, once we've sorted out how you handle pain we can discuss post-surgical discomfort. It also differs quite a bit depending on the type of procedure you're having (tendons vs. bone, toes vs. ankle), but in the grand scheme of things there are common precautions you can take after surgery to minimize your pain no matter what surgery you have.
 
First and foremost, we're going to give you post-op pain medication. We prescribe pain medication based on your procedure, if you take other prescriptions, and if you have any allergies or intolerances. Many people experience some nausea with narcotics (very normal), so we prescribe an anti-nausea drug to go along with some of the pain meds we give you, and we are always available to adjust the dosages up or down if necessary. Our goal is to keep you comfortable.
 
During the first week after surgery it's extremely important to elevate. The more you elevate, the less you swell. The less you swell, the less you hurt. Swelling is a big part of any podiatric surgery because the foot and ankle are the lowest point of your body when you're mobile. If you're standing--even if you aren't putting any direct pressure on the injured or surgical altered foot--the foot is dangling and gravity is helping your body pulse fluid to that spot. The bigger that foot gets, the tighter the skin gets, and the more uncomfortable you become. 
 
The solution to this is elevation. "Water runs downhill" is a good phrase to remember: if your foot is in front of you on a foot stool while you sit in a chair, it's still lower than the rest of your body. Gravity will still make it swell. A better position would be on the couch, bed, or in a recliner with your foot propped up on pillows in front of you. The best place for your foot during the first week after surgery is at the same level as your heart.
 
In addition to medication and elevation, ice packs behind your knee or to your ankle work nicely (avoid putting the ice directly over the surgical site) for 5-10 min/hr. Having a buddy stay with you (family member, significant other, friend) to help you with food, getting to and from the bathroom, and with general cleaning and organization lowers your stress level. This is fantastic, because not only can stress make your perceived pain level worse, but it has also been shown to delay wound healing. 
 
Surgery is generally not a completely pain-free process, but when you know what to expect and have the tools to get actively involved in your pain control, podiatric procedures aren't quite so scary. Your surgeon is on your side, and the whole reason for surgical intervention is generally to decrease pain or deformity--often both--so talk to your doctor if you have concerns. Our goal is to keep you comfortable!

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Guest Friday, 18 August 2017

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