Whenever you go through a foot surgery such as ligament reconstruction, there will be a period where you must remain non-weight bearing. In many cases, when you receive a knee or hip replacement, your physician wants you to walk immediately. However, for a lot of foot and ankle procedures, movement doesn’t promote mobility and healing—it hinders it.
Learning how to get around after foot surgery may seem daunting, but properly caring for your joints during foot surgery recovery is crucial for returning to normal activities. You don’t want to go through surgery but neglect proper recovery protocols and find yourself repeating the cycle all over again.
Our foot and ankle physician, Dr. Kneidel, focuses on providing the best outcomes for his patients at Kansas City Orthopedic Alliance. Even after surgery, he remains at his patients’ side until they are fully healed and feeling better. To him, the recovery process is just as, if not more important than the surgery itself.
Read on to learn more about types of foot surgery, foot surgery recovery, and how to get around after surgery.
Foot and ankle joint anatomy
The complexity of recovery stems from the complexity of the foot and ankle themselves. As with other joints in the body, the foot and ankle are composed of bones, nerves, muscles, ligaments, and tendons to stabilize the area and promote a full range of motion. One of the biggest differences between the foot and ankle and other joints is the number of bones.
For example, the hip joint is created by the ball-shaped head of the thigh bone (femur) articulating with the hip socket (acetabulum)—two pieces to create movement on various planes. On the other hand, the foot and ankle are a collection of joints; you can imagine this as a cluster of small bones working in harmony. Some of the joints are essential, meaning they are more mobile; others are considered non-essential from a biomechanical standpoint (but it doesn’t mean they are less important).
With strong ligaments to support the joints, the foot and ankle are able to move properly without causing pain. However, that is not always the case. Whenever anatomical elements become injured or have abnormalities, that can greatly impact someone’s daily life, including the ability to walk.
The importance of ankle and joint stability during recovery
Joint stability plays a crucial role in the ability to walk. During the recovery process, avoiding weight on your foot and ankle promotes proper ligament and tendon healing. This allows you to become strong enough to begin physical therapy and later return to regular activities.
How is instability determined?
Patients with severe instability often visit Dr. Kneidel and complain they are “rolling their ankle” a lot or their ankle keeps “giving way.” This is a typical sign of chronic ankle sprains due to ligament laxity. If the condition isn’t as severe, patients may have subtle instability that may gradually decrease physical performance. For example, if someone is a runner, subtle instability could cause their running times to fall.
Instability may also come with uncontrolled pain and swelling that doesn’t resolve itself. In that case, it is important to have a physician thoroughly examine your ankle, including proper imaging (i.e. X-rays or MRIs).
In many cases, instability comes from the resulting ligament injury after an ankle sprain. Remember, the ligaments are the primary stabilizers of the ankle; the tendons surrounding them are the secondary stabilizers. Therefore, whenever you have an ankle sprain, strengthening those secondary stabilizers (specifically the peroneal tendons) is vital for the ligaments to heal themselves.
Once you have spent about six weeks off of your ankle, you need to protect the ligaments with a brace and rehab the tendons. This allows you to break the instability cycle to prevent injuries in the future.
Does instability only come from sprains?
No, instability isn’t limited to sprains. Instability may also come from generalized ligamentous laxity or diseases that cause loose joints (such as Ehlers-Danlos syndrome). However, most cases are post-traumatic, meaning there was an initial injury that led to the instability.
Types of foot and ankle surgeries at KCOA
Depending on your condition, there are various types of foot and ankle surgeries Dr. Kneidel provides. Many procedures require you to stay off your feet to promote healing and effective recovery. A few of these procedures include:
Accessory Navicular Excision
In infancy and early childhood, many bones start as less durable cartilage that haven’t been calcified, so an accessory navicular typically doesn’t cause issues until later. When the calcification process begins in the foot, the accessory navicular hardens into a bone sitting on the inner center arch. This usually begins during adolescence (around ages 12 and 13).
In many cases, patients come to Dr. Kneidel believing they have a sprain when it’s actually the extra bone. To treat the issue, he performs an accessory navicular excision, which removes the excess bone to alleviate pain and discomfort.
Tarsal Coalition Surgery
A tarsal coalition is an abnormal connection between the bones in the back of the foot (tarsal bones). Similar to Accessory Navicular Syndrome, this connection doesn’t often cause issues until adolescence. Tarsal coalitions can lead to pain, stiffness, and severe flatfoot. Surgery may include removing the connection (bar) or fusing the joints.
Tendon Transfer
Tendon tears may come from trauma or repetitive motions that add pressure to the ankle. The severity of the tear plays a huge role in the treatment options. Some may benefit from bracing and injections, while others may have to undergo surgery.
Many older patients suffer from chronic inflammation at the insertion of their achilles, which can make maneuvering through daily tasks difficult. For these patients, Dr. Kneidel performs a tendon transfer and reconstructs the achilles with a tendon that flexes the big toe.
Brostrom Ligament Reconstruction
By far, chronic ankle sprains are the most common condition Dr. Kneidel treats in his practice. As an ankle sprain doctor, Dr. Kneidel often performs a Brostrom ligament reconstruction to repair chronic ankle sprains. During surgery, he starts with an arthroscopy where he guides a small camera (arthroscope) into the joint to clean up scar tissue. After, he makes a small incision (about 2 to 3 inches) over the ligaments at the lateral ankle. From there he repairs the two ligaments:
Anterior TaloFibular Ligament (ATFL): The ATFL is the most commonly injured ligament after a sprain and is important for stabilizing the ankle to prevent inversion.
CalcaneoFibular Ligament (CFL): The CFL is also important for preventing inversion, particularly during dorsiflexion (pointing the toes upward).
Typically, repairing the ligaments includes sutures, then reinforcing those sutures with a covering over the tendons at your ankle. In some cases, Dr. Kneidel may add more reinforcements via an internal brace, which is a suture attached to two screws stretching from the talus (ankle bone directly under the shin bone) to the fibula (smaller leg bone lateral to the shin bone).
Foot surgery recovery and what to expect
Most foot and ankle surgeries Dr. Kneidel performs are outpatient procedures, so you don’t have to worry about spending the night in a hospital. In most instances, Dr. Kneidel uses a surgery center rather than a hospital for surgery, which comes with a lower infection rate and more personable atmosphere.
Directly following surgery, Dr. Kneidel will put you in a cast, and you will have to remain non-weight bearing for six weeks.
You will go into the office to change your cast several times after surgery. After the first two week, you will have your first follow-up visit. This gives Dr. Kneidel a chance to assess the wound and provide a more comfortable cast. During your second visit, he completely takes off your casts, re-examines the wound, removes the staples, and reapplies the cast. After six weeks, most patients are free from the cast, able to walk with a brace, and can begin physical therapy.
Keep in mind no one returns to 100% after surgery. If you are 30 years old, you’re not going to have the same reaction as someone who is 18 years old. However, many patients can return to 95% and not have to worry about their injury or pain. The goal is to give you the ability to return to sports and daily life with your post-operative foot and/or ankle. To get you to that point, you must take the proper precautions and learn how to get around without applying weight to the foot and ankle.
How to get around after foot surgery
While walking is out of the picture, there are still ways you can maneuver through your daily tasks without added pressure on the foot. If you ever have specific questions based on your living situation, you can always speak to Dr. Kneidel for more personalized advice and suggestions.
Use tools and devices
During the non-weight bearing portion of foot surgery recovery, crutches are often a good choice to move around without walking. Crutches do require upper body strength, so if that doesn’t work for you, there is also something called a roller aid. With a roller aid, you place your knee on its surface, which enables you to glide around without worrying about exhausting your upper body. Some patients also benefit from an iWalk (a crutch alternative that you strap onto your knee), or walkers work to move around.
Take advantage of your support system
If you have a good support system at home, ask them to help you with tasks as much as possible. That way you won’t have to worry about moving on your foot. For example, if you’re the one who usually cooks, maybe have your spouse cook more often, even if it is just a few times a week. Close family or friends could also help with smaller tasks like grabbing the TV remote or getting a glass of water. The goal is to move as little as possible if you can.
Be okay with temporary limited mobility
At the end of the day, you will have come to terms with less mobility. There are things you won’t be able to do (like working out), so preparing your mindset for those changes can help with frustration. When you’re not as worried about moving around everywhere, you can focus more on healing your body so when the time comes, you can enjoy walking freely without pain.
Get to know Dr. Kneidel at KCOA
Dr. Kneidel is our only physician who focuses on orthopedic foot and ankle diagnoses and treatments. In 2002, he gained a fellowship in foot and ankle at the American Sports Medicine Institute, and since then he has grown his practice to serve young children, adolescents, and adults. With his dedication to his patients and passion for foot and ankle complexities, he offers the best treatments for his patients’ needs.
KCOA’s private practice model ensures Dr. Kneidel can provide his patients with the most value that doesn’t involve hidden fees or outlandish pricing.
The core of his success lies in proper diagnosis. An appointment with Dr. Kneidel includes the highest quality technology to pinpoint a patient’s underlying musculoskeletal conditions. From there, he can better understand which foot and ankle treatment will work best for you.
For a thorough evaluation with Dr. Kneidel, call us at 913.319.7600 or schedule an appointment today.
