Before Surgery

Jeff and his Team will assess you carefully at your consultations and will order all necessary tests and investigations to determine the best way forward.

Please bring all hard copies of X-rays, CT, MRI to any appointments with us, as we cannot always access images online. Please also bring these on the day of surgery, as they are useful for Jeff and his team to refer to during your procedure.

Jeff and his team will assess your medical, surgical, and anaesthetic risk before surgery. Foot and ankle surgery is generally considered to have a lower anaesthetic risk profile than say hip and knee surgery, as blood loss is not as significant. On occasion, we will arrange for you to talk with one of our anaesthetists beforehand if there is a specific issue, to allay any of our or your concerns.

You will need to stop taking any medications that thin the blood some time before surgery to reduce the risk of bleeding both during and after your procedure.

Below is a general guide as to when you should stop taking your medication:

• NSAIDs (Non-Steroidal Anti-Inflammatory Drugs) e.g. Neurofen, Voltaren, Mobic, Celebrex – 5 days before surgery
  
• Aspirin including Cartia – 7 days before surgery
  
• Warfarin – at least 5 days before surgery and an INR taken the day before or early on the day of surgery; it will be restarted soon after you arrive back on the ward that evening if there is no post-op bleeding
  
• Factor Xa inhibitors e.g. Apixaban (Eliquis), Rivaroxaban (Xarelto), Dabigatran (Pradaxa) – 2 days before surgery

Strict guidelines exist around when you need to start fasting for both food and drinks.

Failure to observe these instructions could lead to a significant anaesthetic complication such as aspiration of food into your lungs.
The hospital will inform you the day before your surgery precisely what times to stop eating and drinking from.

Current ANZCA guidelines for adults state a light meal (toast/cereal) can be consumed up to 6 hours before surgery. Unlimited fluids may be consumed including thickened fluids such as milk up until 6 hours before your surgery. Thereafter, you are generally allowed sips of clear fluid only (water, apple juice) up until the time of your admission to hospital which is generally about 2 hours before your designated surgery time.

Being able to park in designated disability parking areas will make life a lot easier and safer when you start getting about again. It will reduce overall pain and swelling and help reduce the risk of falls in public areas.

We generally recommend patients apply for such a permit if they are having any bony procedure, or if their recovery involves casting/booting and/or a period of altered weight-bearing e.g. crutches, knee scooter.

Please click on the PDF download link here and fill in page 2 of the form. Bring the from in person to the rooms or your surgery, and Jeff and his team will fill in the rest for you. Thereafter, you will need to bring this to your local Service NSW centre along with relevant proof of identity (see page 1. of the form). You will need to take a photo and pay a small nominal fee. Bear in mind that processing time is roughly 2 weeks, and the permit is posted to your home address.

Certain medications can affect the outcome of your anaesthetic or surgery. We have already mentioned blood thinners above as one such class of medications.

Jeff and his Team will review your medications before surgery and determine which need special consideration around the time of your surgery.

Some medications such as immunosuppressants for autoimmune conditions e.g. Methotrexate, can affect wound healing and may need to be stopped some time before surgery. Others, such as the newer GLP-1 agonists for weight loss e.g. Ozempic, can slow gastric emptying and need to be stopped four weeks before surgery.

Discuss any medications you are taking with your doctors to see which ones you should stop taking before surgery. If you have any concerns, please contact Jeff’s rooms or your anaesthetist.

All surgery requires surgical incisions through the skin. Any breach in the skin (ulceration) has a small risk of infection until the wound has healed. Some skin conditions or ulcerations around the surgical site can increase the risk of infection. If you have any open or inflamed wounds on your operative limb in the days leading up to surgery, please call Jeff’s rooms. In some surgeries (especially joint replacement), we need all skin breaches healed before proceeding to surgery.

You should remove any nail polish from your feet some days before your surgery as this will help prevent infection. Nail polish can also make vascular or blood flow checks to your toes more difficult in the post-operative period.

Smoking and foot and ankle surgery is not a great combination. It interferes with wound and bone healing.

The blood vessels (think pipes that blood flow through) are much smaller in diameter at the feet and are much more vulnerable to the effects of Nicotine. Nicotine is a vasoconstrictor which means it tenses the muscles in the walls of the blood vessels, causing them to narrow in diameter. As the blood vessels are already small to begin with in the feet, every Nicotine hit can starve the area of blood flow which is critical for healing.

Quite apart from this, smoking also affects lung function and increases your risk of an anaesthetic complication.

Eliminating smoking will reduce your surgical risks and improve your outcome.

Jeff understands that this can be easier said than done and is always happy to discuss strategies to cut down around your surgery. Enlisting the help of a trusted family GP can be very helpful as well as your loved ones to keep you on track.

Jeff and his Practice Nurse will talk you through what equipment you will need and where you can rent or purchase them.

Crutches, and post-operative shoes are provided by the hospital where you have your procedure.

If you need a moon boot for some of your recovery, our practice carries a supply, and Jeff and his Team will provide and fit you with an appropriate boot for purchase.

If you need either a knee scooter, wheelchair, forearm support frame, or shower chair, you will need to hire these yourself. Jeff and his Team recommend Independent Living Specialists   which is a fantastic state-wide service for all your equipment needs and will deliver all equipment to your home after you complete an online form.

Knee scooters are recommended if you will be non-weightbearing for a period of 2 or more weeks, or if you feel you may struggle non-weightbearing with crutches. They are a great way of getting about and improving your mobility whilst you are non-weightbearing.

Wheelchairs are only used when you have had both legs reconstructed and you are non-weightbearing for a certain period. E.g. bilateral flat foot reconstruction.

Forearm support frames, as with wheelchairs, are only used when you have had both legs reconstructed and become relevant after you have completed your initial non-weightbearing period of 6 weeks.

We recommend a shower chair and a re-usable waterproof limb protector for just about all patients having foot and ankle surgery. You will need to keep your limb dry for at least 1 - 2 weeks, hence the need for a re-usable waterproof limb protector which can be purchased at your local chemist or online on sites like Amazon. Sitting down for showers is always recommended to reduce the risk of falls. Even if you are allowed to fully weight bear immediately after your procedure, it is easy to slip over whilst wearing your waterproof limb protector. Instead of a shower chair, you may wish to use a plastic garden chair or outdoor piece of furniture which is fine as long as it is stable.