Complications of Foot and Ankle Surgery

Anytime surgery is performed there is the possibility of complications.  We'll review the most common here. 

Pain  

Pain following surgery is usually the patient's biggest concern.  But while a certain amount of discomfort can be expected immediately following any surgical procedure, post-operative pain is not usually severe.  Our average surgical patient takes just one or two pain pills following most procedures. 

When severe pain develops immediately after a surgery, it is usually caused by an overly-tight bandage (which can mean the cutting off of circulation and potential loss of part of the foot), or by the patient's being excessively active after the procedure.   

When pain develops a few days after the procedure, we would have to consider infection the most likely cause, though other causes are definitely possible. 

For some conditions, long-term aching may persist several weeks, particularly if the patient doesn't perform range-of-motion exercises to regain normal motion, or if the patient doesn't follow post-operative instructions. 

Keep in mind that throughout all stages of healing, those who smoke tend to develop more pain than normal. 

Infection

After pain, infection is the patient's second biggest worry about surgery.  And it's certainly a legitimate concern, because  while the surgical procedure is done in a sterile manner (with sterile instruments, sterile gloves, sterile gowns and so forth), the patient's own skin can never be made 100% clean before the procedure, and it is possible for bacteria--almost always from the patient, himself--to enter the wound and cause an infection.

That said, we have to keep in mind that infections are rare.  Most estimates run in the 1-3% range, lower when the case is done away from a hospital, (which tends to have more virulent organisms from the sick people there.)  

When infections do develop, they usually start out in the skin and soft tissues, and are usually readily treatable with oral antibiotics.  Oral antibiotics may not work, however, for several reasons.  For example, oral antibiotics may not work if the antibiotic chosen isn't effective against the infecting organism, if the organism is a strain resistant and insensitive to the antibiotic, if the patient's circulation isn't adequate to deliver the antibiotic, or if the infection involves an area (like bone or an abscess) that the antibiotic cannot reach.  

When oral antibiotics don't resolve the infection, intravenous (I.V.) antibiotics are usually the next step.  I.V. antibiotics are often stronger or able to be delivered in greater doses than oral medications.  

In rare occasions, Infections may proceed to joint or bone, or spread around the body, (bacteremia), a situation that usually requires I.V. antibiotics and surgery to address.   

Signs of infection include excessive pain, redness around the surgical site, discharge from the surgical site, fever, sweats, chills, fatigue.  For more information about infections, visit our web page about infections in general, or about differentiating infections from inflammation.

In cases of unresolving infection, a vascular consult (to make certain adequate circulation is present) or an infectious disease (I.D.) consult may be suggested.  

 Swelling

While pain and infection are usually the patientís biggest fears concerning surgery, the most common complication encountered with foot surgery is excessive swelling (edema).  In fact, some degree of swelling occurs in virtually all surgical patients, and excessive or persistent swelling occurs in about 20% of surgical patients.  Swelling is particularly common with foot surgery because the feet are furthest from the heart and because fluids tend to settle in the direction of gravity.  Toe surgery in particular tends to develop swelling, particularly when the patient is too active or wears shoes that squeeze the foot. 

If excessive swelling develops, you may need to stay off the foot and elevate the foot more frequently or for a longer period of time.  The continued use of compressive bandages, oral or injectable medications, longer periods of non-weight bearing, inactivity or time off work or school may be necessary to treat swelling.                                                                                 

Sensory Changes 

When the skin is cut, there are small nerves within the skin are cut, too.  This nerve trauma may lead to a change in sensation.  Most frequently this may mean a temporary loss in sensation (numbness), but it may sometimes result in an increase in sensation (for example, hypersensitivity or pain), or peculiar sensations (for example, pins and needles sensations, or a feeling of burning or excessive cold). 

These sensory changes are usually temporary, lasting days, weeks or months.  But sometimes sensory changes may take take 1-2 years to heal.  And very rarely, these sensory changes may be permanent.   

Scarring

When the skin is cut, a scar develops. 

In some patients prone towards scarring, abnormal scarring may develop.  It may look unattractive, become enlarged or thickened, develop changes in pigment (skin color) around the scar, or become sensitive. 

While we attempt to minimize the potential problems associated with scarring (by placing incisions in areas that are less susceptible to problematic scar formation, by making curved or odd-shaped incisions that diminish tension, or by using certain types of suture or closure methods, for example), the foot itself is particularly vulnerable to problematic scar formation because there is increased tension on the skin from swelling and from weight-bearing.  Because you walk on it, the bottom of the foot is particularly sensitive to problematic scar formation.

 Delayed Healing

Blood tests and vascular tests (pulses, capillary filling time, for example) are usually needed to give a good indication whether the patient is a good surgical risk, but it is always possible that a patient may not heal as quickly or as well from a surgery as expected or desired.  This is particularly true in diabetics, smokers, people with heart and circulatory disorders, those with arthritis or other general medical conditions, but slower-than-desired healing may occur with anyone.   

Bones usually heal in 6-8 weeks.  When they are slow to heal, they would be classified as a "delayed union".  Rarely, (less than 1%), the bones may never heal, something called a "non-union". 

Soft tissues, too, may heal slowly.  Wounds may dehisce (pull apart before they are healed), weep or discharge, or ulcerate.  In rare cases, (less than 1%, but more common with diabetics and those with poor circulation), soft tissues may necrose or die. 


When post-operative problems develop following surgery, it is particularly important to let your surgeon know about any complications that are developing and to follow post-operative instructions closely.  


 

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This website is operated by 
The Achilles Foot Health Centre
S. A. Schumacher, D.P.M., F.A.C.F.A.S., F.A.C.F.A.O.M.  
Dr. S. A. Schumacher, Podiatric Corporation  

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