Podiatry FAQs

Podiatry Surgery

  1. Should I have surgery to fix my foot or ankle problem?  
  2. Why do the foot and ankle take so long to heal?  
  3. How well does surgery work?  
  4. Are there complications of foot and ankle surgery?  
  5. How much pain am I going to have?  
  6. Can I shower or bathe after surgery?  
  7. Will I have a cast?  
  8. Can I drive after surgery?  
  9. How much time do I have to take off work?  
  10. Is physical therapy necessary?  
  11. What kind of anesthesia is involved?  
  12. What is a tourniquet?  
  13. Will I be admitted to the hospital?  
  14. Will my insurance pay for surgery?  
  15. Who do I call after surgery if I have questions?

1. Should I have surgery to fix my foot or ankle problem?
The decision to have foot or ankle surgery is a complex one. Recovering from foot or ankle surgery could require that no weight be put on the involved extremity for six to eight weeks, followed by a short period of time in a walking cast. This significantly impacts a normal lifestyle and it may take many months to fully recover. However, surgery does provide acceptable pain relief and return to function. It is useful for treating conditions that have not responded to non-surgical methods, especially when there is bone, joint, ligament or tendon damage.

2. Why do the foot and ankle take so long to heal?
The foot is the first structure to hit the ground bearing weight. It has to disperse greater force than any other joint in the body. After an injury or surgery, it can take a long time for the foot and ankle to be able to handle normal weight loads without pain or further damage.

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3. How well does surgery work?
Foot and ankle surgery works very well when the correct procedures are chosen for specific problems. The more focus on pain relief as the primary reason for surgical intervention, the higher chance of success. Patient satisfaction after foot and ankle surgery is well over 90 percent.

4. Are there complications of foot and ankle surgery?
No surgical procedure is without potential complications. But most complications are minor and do not affect final outcome. These can include swelling, numbness, excessive scar tissue, superficial infections and acute pain. Some complications can affect the final outcome of surgery. These include, but are not limited to: continued pain, worsened pain, recurrence of the problem or deformity, delayed or nonunion of bone correction and hardware failure.

The three most potentially serious complications following surgery are Osteomyelitis (bone infection), DVT (deep vein thrombosis or blood clot) and CRPS (Complex Regional Pain Syndrome). Virginia Mason has standard procedures in place to quickly recognize and treat these complications when they arise so long-term complications can be minimized.

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5. How much pain am I going to have?
Generally, foot and ankle surgery is not tremendously painful provided you follow postoperative instructions. A numbing medicine is placed around your ankle after surgery. You may not have any pain for four to 24 hours after surgery. The more your foot is elevated above heart level after surgery, the better you will feel. We give painkilling medications after surgery, but most people do not need to use these medications longer than a week.

6. Can I shower or bathe after surgery?
For most procedures, you cannot get your surgical site wet until the stitches are removed. This is usually done 10 to 14 days after surgery. You will be given a special bag to keep the surgical area protected while showering or bathing. If there is external hardware, you cannot get your foot wet until the hardware is removed, usually about six weeks after the procedure. After the stitches or hardware are removed, we require that you avoid soaking your foot in a bath tub, hot tub or swimming pool for an additional two weeks.

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7. Will I have a cast?
That depends. Some procedures only require a protective shoe postoperatively. Others require a postoperative cast for one to two weeks, followed by a removable walking cast or boot. The walking cast is then worn for protection during the remaining period of not putting weight on the leg and as protection to transition from this stage to weight-bearing.

8. Can I drive after surgery?
You need someone to bring you to your surgery and take you home. You should avoid driving for the first week after surgery no matter what was done. After that, driving depends on your transmission and which foot was operated on. If you have a manual transmission, you cannot drive during the entire non-weight-bearing period. If you have an automatic transmission, you may drive if your left side was operated on. If your right side had surgery, you should not drive during the entire non-weight-bearing period, which may be six to eight weeks. If you absolutely have to drive after foot surgery, there are left-foot accelerators that can be installed.

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9. How much time do I have to take off work?
If your job can accommodate non-weight-bearing use of your leg, then you can usually return to work three to five days after surgery, depending on your pain. If your job will not accommodate non-weight-bearing use of your leg, you will have to be off work during this recovery period and need to have modified duties when you return until you are out of your protective boot.

10. Is physical therapy necessary?
Physical therapy (PT) is patient and procedure-specific. Usually, PT is necessary for major reconstructive procedures and in situations where transient complications such as excessive scar tissue or stiff joints occur.

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11. What kind of anesthesia is involved?
Anesthesia is based on the length of procedure, type of tourniquet used and your anesthesia wishes. The options include local anesthesia, regional blocks (popliteal/spinal) or general anesthesia. All local and regional anesthesia is accompanied by conscious sedation so that you are unaware of the procedure. Our primary goal is to provide you the safest, pain-free anesthesia.

12. What is a tourniquet?
A tourniquet is a cuff that is placed around your ankle or thigh during surgery to stop the blood flow to your leg. This allows us to be more efficient. A tourniquet is safe for up to two hours and can be deflated and reinflated for longer cases.

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13. Will I be admitted to the hospital?
Unless your surgery is done on an emergent basis, or there is a significant complication, you will not be admitted to the hospital. Most surgeries are done on an outpatient basis and you can go home the same day as your surgery.

14. Will my insurance pay for surgery?
Most foot and ankle surgery is considered elective. However, if it is being done to reduce pain and dysfunction, most insurance plans have good coverage for elective foot and ankle surgery. It's impossible to know the details of each individual plan, so it is up to you to determine whether your insurance will pay for surgery. Virginia Mason can supply procedure codes for your insurance company and you can contact our billing department to find out how much we charge for certain procedures. In addition to your surgeon's fees, there are anesthesia charges and facility fees that come with using the operating room.

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15. Who do I call after surgery if I have questions?
Your surgeon will give you contact information and be available to answer questions after surgery. Some surgeons work with residents or fellows, and if they are involved with your case, you will also be able to contact them after surgery.

Corticosteroid (Cortisone) Injections  

  1. What are steroids?  
  2. What do steroids do?  
  3. How do steroids decrease inflammation?  
  4. Are steroids safe?  
  5. Steroid injection or pill?  
  6. Is there a limit to the number of injections I can have?  
  7. What else can I take?

1. What are steroids?
Steroids are hormones produced by the body that have many metabolic functions. The steroids Virginia Mason podiatrists use for controlling inflammation are called corticosteroids. They are produced by the cortex of the adrenal glands above your kidneys. Therapeutic steroids are synthetic analogs of the body's naturally occurring corticosteroids — cortisone and hydrocortisone — and come in injectable and oral forms.

2. What do steroids do?
Corticosteroids have many metabolic functions, the most potent and primary function being their anti-inflammatory properties.

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3. How do steroids decrease inflammation?
When cells are injured, they release products called phospholipids. Enzymes called phospholipases convert phospholipids to arachidonic acid. Arachidonic acid (AA) is the chemical mediator of inflammation in the body. AA goes through several different chemical reactions (called oxygenation) to produce several chemical mediators of inflammation (leukotrienes, prostaglandins, and thromboxane). These chemicals have many effects which include blood platelet aggregation, increased cell permeability (swelling), further recruitment of inflammatory chemicals (histamine, serotonin, bradykinin), and recruitment of cells called macrophages (these cells remove damaged tissue but their byproduct is scar tissue).

Corticosteroids are phospholipase inhibitors that prevent phospholipids from converting to AA, thus stopping inflammation at the beginning of the process. Corticosteroids have what is called a catabolic or "breakdown" effect, which is how they decrease scar tissue. The mechanism of this effect is unknown.

4. Are steroids safe?
Corticosteroids are very safe and effective in low doses. Side effects occur in less than one percent of patients and usually involve facial flushing, insomnia, increased irritability and increased pain.

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5. Steroid injection or pill?
Steroid injections are more effective because the potent anti-inflammatory is administered directly into the painful area. Absorption is very slow, so side effects are rare. The injections, however, are fairly painful. The oral form of steroids are not painful, but they have more side effects and do not work directly on the painful area.

6. Is there a limit to the number of injections I can have?
Although it is known that too much cortisone is harmful, an absolute maximum number of injections has never been established. As long as the injections are providing a therapeutic benefit, a series of up to six injections is well-tolerated (most people only need one to two injections).

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7. What else can I take?
Nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen and naprosyn are safe and effective, but only work on certain portions of the inflamed area. They do not have any effect on scar tissue. Tylenol is not an anti-inflammatory.

Custom Orthotics

  1. What is an orthotic?  
  2. How do orthotics work?  
  3. Do I need a custom orthotic?  
  4. How long do orthotics last?  
  5. Will my insurance pay for orthotics?

1. What is an orthotic?
An orthotic is an insert, either soft or firm, which replaces the insole of your regular shoe. It is classified as either custom or over-the-counter (OTC). Custom orthotics should only be made by a podiatrist or physical therapist who has experience treating foot and ankle disorders. The best OTC orthotics are available at running stores or specialty shoe stores. It is recommended no more than $60 be spent on an OTC orthotic because the money might be better used toward having a custom-fit orthotic made.

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2. How do orthotics work?
Hundreds of scientific studies have been performed that demonstrate orthotics perform three major functions:

  • First, orthotics help disperse forces across your foot so one specific area is not getting overloaded.
  • Second, orthotics help slow down pathologic motion, such as overpronation (too much inward roll) or oversupination (not enough inward roll).
  • Third, orthotics improve what is called proprioception, which is your foot's awareness of its position in relation to the ground. This is a subconscious, neurological pathway, and one reason orthotics usually feel good when you put them in your shoes.

3. Do I need a custom orthotic?
Although over-the-counter orthotics work, custom orthotics work better and are more comfortable. We recommend them when over-the-counter orthotics fail to relieve symptoms. Custom orthotics are made of higher-grade materials that last longer and are more expensive. When a custom orthotic is necessary, it is crucial that a podiatrist is involved, as the wrong type of orthotic can actually make a condition worse or even cause a different problem.

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4. How long do orthotics last?
This depends on the type of activity. The more running one does, the quicker the orthotic will wear out. Over-the-counter orthotics typically last about one year. Custom orthotics usually last three to five years – sometimes longer. With children, we usually replace orthotics every one to two shoe sizes, depending on comfort.

5. Will my insurance pay for orthotics?
We recommend that you contact your insurance company to find out what your plan will pay for. Virginia Mason accepts the following health insurance plans.

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If you have questions or would like to schedule a consultation with a foot and ankle specialist, call us at (206) 341-3000.

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