Patient Information

Important information for patients

General information Foot and Ankle Diagnosis and Treatment:

Important information prior to Surgery

Noodsaaklike inligting voor operasie

This information is intended to provide you with additional information about your proposed treatment and assist you in making an informed choice. Information specific to your own planned operation will be discussed.

You should discuss your preferences with the anesthetists.

We provide most patients with a special post-operative shoe or a cast after their foot surgery which will accommodate the bandages.

This will depend on the type of surgery you have had.  You will be told beforehand if crutches or a cast are required following your surgery. Our physiotherapists will teach you how to safely use crutches if necessary. They can also be purchased from us.

Once you have decided to have surgery, you will be provided with an admission form for the hospital via email.  Please complete and forward to address provided or to your pre-admission at the hospital.

If your surgery is scheduled for the morning, you have to eat your last meal before midnight the previous evening. If you are scheduled for the afternoon, your last meal must be before 7:00 on the morning of the surgery.

  • When you arrive, you will be welcomed by the pre-admission department who will have somebody escort you to your room.
  • The consent form will be signed and you are able to ask any further questions.
  • The surgery site will be marked and you will confirm the location of your surgery.
  • Our physiotherapist will go through the use of crutches before and after.
  • The anesthetists will talk to you about your anesthetic and general health.
  • Cape Gate Anesthetists – Dr Morkel, Slabbert or Viljoen.
  • Northern Anesthetic Practice – Dr Leerkamp or Coetzee.
  • We will make you comfortable in the ward. The anesthetist will consult with in the ward and prescribe premedication to help with any anxiety.
  • Once back in your room, each of the team will see you again and make sure you are comfortable.
  • A special post-operative shoe will be applied to the foot if needed.
  • You can eat once you feel well enough or awake and you will be provided with a welcome drink after a period of fasting.
  • We will talk to you about the surgery and answer any questions.
  • X-rays are usually taken in theatre so you do not need to schedule further appointments.
  • If you stay overnight, we will of course make your stay comfortable and provide for your hospital needs.
  • The physiotherapist will guide you to mobilise as soon as it is safe.
  • You will be discharged when it is safe to do so. This will depend on the complexity of the surgery and your mobility. We expect you to have someone stay with you overnight. You cannot drive and we prefer to escort you to a car by wheelchair for your own safety

Some foot surgeries can be done as day case surgeries. This means that you are able to go home the same day, but it will depend on the complexity of the surgery.

Do not remove the bandage after surgery. The incision sites will be stitched closed and should be kept dry for two weeks. Stitches will be removed 10 days later.

You will be provided with postoperative instructions and useful information including any contact numbers for the ward. Contact the 24-hour service at Louis Leipoldt Emergency Centre or your GP if you need to come back in. They will contact us if any emergency intervention is needed.


When should you be worried?

  • If you feel unwell and have a temperature.
  • New onset of pain that is progressive.
  • If your toes become blue or if you are unable to move them.
  • Blister-like pain and rubbing under the cast/boot
  • Discharge, wetness or foul smell under bandages and cast.

If you are able to return to our offices, it is ideal in case we need to arrange other services (Monday to Friday 8:00 – 17:00).

We will always try to see you as soon as possible. If we are not available, we will inform you of another colleague (orthopedic surgeon) that will be on standby. We try to cover all aspects by planning ahead.

You are advised to rest after surgery.  The amount of time required varies according to the type of surgery and your own circumstances. Your own circumstances will determine when you feel ready to go back to work. If you have an office-type job and you can elevate your leg and likely return to work within a week or two. If your job requires a lot of walking or is strenuous then you may need longer rest. Sick leave forms will be issued from the ward for a limited period. To extend the note please see your own GP or discuss this with us personally. We will send a discharge letter to your GP so he knows when you have left our care. 

When considering whether or not to have surgery, you need to carefully ensure you have booked no holidays close to the date of surgery and allow plenty of time for recovery.

It is a good idea to get things organised for your discharge from hospital. Below is a list of things to organise:

  • Help with household tasks
  • Food cupboards stocked up
  • Help with shopping
  • Help with children, pets and relatives arranged for your return home
  • Transport to and from hospital.

You can fly to a holiday destination depending on the length of flights, but discuss this you’re your doctor in before your surgery.

You will need to keep your leg elevated 50 minutes out of every hour for the first 2 weeks. This prevents your incision from leaking and becoming infected. You will also be required to rest after your surgery. How much rest and how much activity you are allowed to undertake will be discussed with you before and after your surgery. Postoperative recovery times vary between patients.

You are advised to avoid alcohol after your foot surgery whilst on medication. Alcohol may interact with one or more of your medicines in addition to increasing the risk of falls.

Foot surgery may affect the way you walk. Following foot surgery, patients naturally favour the other foot. This is usually temporary until the foot settles and you become accustomed to walking normally again. An insole is often recommended after some surgeries.

This condition sets in when bone loses its blood supply. This may occur after surgery or even from simple trauma. The bone may weaken and change shape. Usually the blood supply will return to the bone with time, but on rare occasions the bone is damaged resulting in problems such as secondary arthritis.

There will be some bleeding after surgery, but this is controlled during the operation.  Infrequently, a small collection of blood in the deeper tissues may form.  Avoid direct pressure on the operation site by using your crutches or walking shoe.

The condition is uncommon and can occur after any type of operation or injury. Persistent and chronic pain develops as well as swelling and colour changes and changes to bones of the affected limb. Treatment requires early diagnosis and referral to a pain specialist. Complete resolution of the condition may not always be possible.

Crutches are available to purchase from us for your personal use. These are not recycled.

Anesthetics are very safe and we take all precautions during surgery. Please advise us if there is any change in your health.  Our hospital is equipped to deal with emergencies. Serious problems following surgery can arise from pulmonary thrombosis sometime after surgery and you will need to go to a hospital with an A&E department. Please call an ambulance if you have chest pain.


Although you will be given an estimate as to how long the recovery process will take, delays in healing can affect the soft tissue or bone. Poor eating, smoking, too much standing can all add to a delay.


After foot surgery, it is not safe to drive until your doctor has cleared you to do so. You must be free of pain and able to perform an emergency stop. If you have had left-sided surgery and drive an automatic car you may be able to drive two to four weeks following surgery. Start by trying the foot pedals on the driveway where it is safe. For your first journey do not travel too far and it is best to have a competent driver with you to take over. You cannot drive with casts and if you fail to follow advice you may invalidate your insurance or have an accident. Your insurance company must be notified regarding the type of operation that you have undergone to ensure that cover is valid.

With some surgeries (such as bunion surgery) full correction may not be achieved, although symptoms are usually improved.

If we have to utilise metal work (pins, screws, plates, implants), these are normally left in place. In about 10% of patients we may have to remove these if they loosen or cause irritation to the surrounding tissues. Once the bone has healed the metalwork is no longer required.


Smoking increases your risk of infection significantly. Infection rates are estimated at less than 5%. If infection does develop it is generally superficial and can usually be treated with antibiotics.  Deeper infection is very rare, although more serious.  Infected bone may need removing which could affect your foot permanently.  Any infection has the potential to be fatal and foot surgery is no exception.  Fortunately, this is rare.

Keloids are large, unsightly scars that are raised up and may extend beyond the margins of the original wound. This is a rare type of scar. Patients will often have a history of poor scar formation or keloids. In patients who have a history of keloids we need to weigh up very carefully the real risk of keloid developing after surgery. If a scar is raised it will usually settle within 24 months. Further surgery is rarely needed and will often seek a second opinion from one of our plastic surgeons if you are worried.

Losing some sensation around or away from the surgical site after surgery is a possibility. Care is taken to avoid damage to nerves and it is rare for a major nerve to be damaged. If nerve damage does occur, it is more often the tiny nerves of the skin, leaving an area of skin with reduced or altered sensation. The sensation may return after about nine months after which time it is usually permanent, but should not trouble you.

This would be a very rare complication of foot surgery.  However, injury to blood vessels or serious infection may lead to loss of tissue in some or all of the foot.  The risk of this for healthy patients is very low

(a discomfort under the ball of the foot also known as transfer pressure)

Foot surgery may alter the pressure under the forefoot, causing discomfort (or making existing discomfort worse). This may need to be treated with insoles and rarely by further surgery.

This term refers to the situation where bone fails to fuse (join) together as planned. The percentage risk varies greatly depending on your general health, whether you smoker or the type of surgery performed.

 If this situation occurs we may:

  • Allow more time for the bones to knit together.
  • Place you in a cast.
  • Re-operate on the bone using a graft of bone from your body.
  • Opt not to take action when there are no symptoms as a result.

You are required to stop taking Ecotrin and Disprin one week prior to surgery. Certain (estrogen containing) oral contraceptive medications are associated with a slight increased risk of thrombosis (blood clots). You may wish to discuss the implications of this with us or your own GP.  Stopping oral contraceptives means you are at risk of pregnancy unless alternative contraceptive measures are taken.

Rheumatoid arthritis treatment is not routinely stopped prior to surgery (some of the newer Biologicals need to be stopped in advance) – please consult with us or your rheumatologist prior to surgery.

It is difficult to predict how much pain you will suffer after the operation as this varies between patients. You may experience more discomfort in the first two days. Our local anesthetic blocks initial pain and medication during and after surgery minimizes further discomfort.

You will be advised to take medication after surgery to help control postoperative pain.  Remember some preparations may upset your stomach. Always try to step down to a low grade pain killer that you are accustomed to.

You are strongly advised to rest after your surgery. Resting with your foot elevated and regular use of an ice pack over the ankle will greatly reduce pain and swelling.

You may have difficulty with shoes after surgery due to swelling. Do not expect to be able to use your regular shoes after surgery.

Smoking has the following adverse effects in relation to surgery:

  • Delays wound healing.
  • The risk of bones failing to join increases by 2.7 times compared with a non-smoker.
  • Increased risk of thrombosis and infections.

When can I return to sport?

Check with us at follow-up appointment before returning to sport. This will depend on the type of surgery performed and the physiotherapist will guide you through this process.

You will need to keep your leg elevated 50 minutes out of every hour for the first two weeks.

This prevents your incision from leaking and becoming infected.

Swelling is always present after surgery as it is part of the normal healing process.  A swollen pain-free foot usually offers no concern. Some patients experience prolonged swelling of the foot after surgery (15%) until 4 months.  Most swelling will have decreased by 12 months.

A thrombosis is a clot which most often forms in veins of the lower. Risk factors for thrombosis are:

  • Previous history of thrombosis.
  • Family history.
  • Certain drugs (e.g. some types of oral contraceptives).
  • Certain (oestrogen containing) oral contraceptive medications are associated with a slight increased risk of thrombosis (blood clots).
  • Prolonged rest periods without muscle activity.

The post-operation thrombosis risk is 1%. If you are at risk, we will provide you with the appropriate medication. We will provide you with T.E.D stockings on your non-operated foot which you will need to wear until you are active again.

The vast majority of patients who undergo foot surgery have few problems. We provide the following to ensure your steady recovery.

  • A summary of your medical history.
  • We manage your expectations.
  • Planning surgery to meet your specific needs.
  • Pre-operative Hibiscrub soap wash.
  • Organising tests from urine sample, blood, ECG (heart).
  • Asking for second opinions before elective surgery.
  • Anesthetist assessment.
  • Admission assessment by nursing (double checks).
  • Anesthetic staff checks.
  • WHO or (world health organisation) international patient checking.
  • Operative monitoring and standard care models.
We hope this information has answered most of your questions about your proposed operation. Please discuss any concerns with us before you agree to surgery.