There comes a time when you decide that nothing else will make your pain go away other than hammertoe surgery.

With great care your surgeon has explained the details of the surgical procedures, discussed with you the things that could go wrong since this is not a perfect world, and developed a game plan for recovering from surgery to achieve the best possible outcome.  At least at Geller Podiatry, this is how it is done.

A great deal of information gets exchanged, but ultimately the days or weeks leading up to your surgery are busy planning for the big day.  You need to schedule time off from work, someone to help with household chores, care for the kids and their needs.  I’ve already written about planning before surgery, but there are little things that can make a huge difference.

What is the biggest obstacle to healing your hammertoe surgery?  After thousands of hammertoes treated at Geller Podiatry the one thing that differs between easy and difficult recovery from surgery is swelling.  Remember what I always say, “You can’t start to heal until inflammation is gone”.  Well one of the key signs of inflammation is swelling.

Toes are small.  There isn’t much room for them to swell.  Increased pressure on nerves causes more pain.  Increased pressure on your circulation to the toe makes healing take longer.   Patients who control swelling from day 1 always have a faster recovery.

The key to controlling swelling:  “RICE”

Rest, Ice, Compression, Elevation

Rest:

The way I discuss surgery with my patients always involves this statement: “No matter how minor you think this surgery is going to be, you need to treat it like it is major surgery”.  If you think you are going to pick up where you left off one or two days after surgery, think again!  Your daily routine will have to wait for your recovery, that’s why we plan before your operation.  First of all rest involves lying down, not just sitting.  you will be prescribed a boot to wear on your foot.  This boot is also part of rest.  The area of surgery will be protected or rested while wearing the boot.  Do not remove the boot until you are told that this is OK.

Ice:

In all of my years of experience I would have to say that ice is possibly the most under-rated anti-inflammatory in the world.  There are some simple rules you need to follow when using ice: 1.  do not put ice directly on your skin; 2. ice is applied for 20 minutes and then left completely off for 40 minutes.  Ice is usually applied to the ankle or behind your knee.  My patients tell me that behind the knee is the easiest and if it’s easy you are more likely to do it.  Put a washcloth over the ice pack and then rest your knee on the ice.  If you leave the ice on for more than 20 minutes or without protecting your skin you could develop a cold injury or frostbite.

Compression:

Keeping snug bandages on your foot help to prevent swelling.  There is a difference between snug and tight.  The appropriate amount of compression is still comfortable.  If your compression is applied too tight you will notice things like the toe changing color, usually blue, but white can also occur.  Numbness and tingling can occur when the bandages are too tight.  If these are noticed call your surgeon and loosen the bandage.  The layer of bandage that supplies the compression is always the outer most layer.  If you need to loosen compression only touch this outermost layer, nothing beneath it without your doctor’s permission.

Elevation:

This is the easiest part, but the one most people fail to do.  Elevation of a foot means getting your foot above your heart.  Remember that the heart is in your chest, so you have to lie down and get your foot up on pillows or the arm of a couch.  A helpful hint is to keep your knee bent slightly for comfort.

A Geller Podiatry, our team spends a tremendous amount of time with you planning for your surgery.  These simple steps are what we see as making the biggest difference between what patients consider an easy recovery vs. a difficult recovery.  Rest, ice, compression, and elevation (RICE) is an old standard because it works.  Don’t underestimate the power of RICE.  I hope you have a wonderful surgical experience when you decide to have your hammertoe surgically corrected.

Paul trained for his first marathon.  He was smart about it going first to his doctor for a physical then having his feet and shoes checked in my office.  His training program included strength training, flexibility, and running.  Paul said the race was hard on his body, but he was happy to have finished.  About 3 weeks later I saw Paul again.  This time he was a wreck.  He was in pain from his low back to his toes.  Paul hadn’t been sleeping well and was just not as happy as he expected to be after completing his first marathon.

I asked about his recovery from the race.  I heard about the celebration that night soaking in a hot tub with friends drinking and eating whatever was there.  His wife had scheduled him for a massage the day after the race.  Paul said it hurt more than it felt good and had no lasting effect.  Stretching was impossible because of the pain and stiffness.  The tight muscles made it nearly impossible to run the few times he had tried.  When I asked if he was following any schedule or program he reminded me of his pre-race training program, but had nothing to follow for recovery.  Do you know what Paul did wrong?

What you do immediately after the race is as important as what you did to get there.  You know that running 26 miles is serious business, that’s why you were so careful in your training program.  After the race you will be exhausted mentally and physically.  Your recovery plan has to be set before you race so you won’t have to think about it.  Your muscles have worked hard for 26 miles and all nutrients in your body have been used.  When your body works hard for a long time you get inflammation.  Treat your body right and this will go away quickly so you’ll be running again in no time.  Ignore the inflammation and you’ll suffer.  I’m sure you’ve heard stories about people who ran a marathon and were never able to run again.  If you ask them about their post-race recovery I bet you’ll get a blank stare.

As soon as you finish the race:

You’re exhausted and legs feel weak, but this is the time you need to keep walking.  Don’t stop and get a chair massage, don’t chat at the booths.  Get your packet, medal, snack pack, and drink water as you walk around.  Make a mental note of what hurts.  I don’t mean big areas like your entire leg.  I mean specific areas like your calf muscle, front of your thigh, back of the thigh, front of your leg, arch, heel, toe.  Pay attention to any pains so that you can address these after a thorough cool down.

Your kidneys have been fighting to balance your hydration and electrolytes.  All the waist products coming from all that muscle action of running 26 miles is filtered by your kidneys.  They have worked overtime and need to recover.  Anti-inflammatory medications stress your kidney more.  This is not the time to take anti-inflammatory medications like Ibuprofen or Naproxen.  Refuel by drinking water, electrolyte drinks are OK, but water has to continue even if you’re drinking electrolytes.  Eat like you did while you were training.  Protein helps repair muscles and carbohydrates help with fuel. 

I don’t know how to describe it, but there’s an excited feeling in your legs, some people tell me a throbbing, others say it’s like their legs are just revved up.  Don’t stretch until that feeling in your legs goes away.  You can ice the sore spots and gently stretch.  When you get home take a cool bath.  Use a foam roller or gently massage sore muscles.  If possible schedule a massage in the evening, at least 4 hours after the race.

Things to avoid:

1. Sitting for more than 10-20 minutes
2. Soaking in warm water or hot tub
3. Sauna
4. Anti-inflammatory medications

The first week:

Inflammation can last 24-72 hours.  You will have to pay close attention to your body. If you treat the inflammation right you’ll be running again after a few days.  Ignore the inflammation and it can become a repeating cycle that is difficult to break even with my treatment.  Have more massages, practice yoga, swim or bike.  Don’t be aggressive, your goal is to stay loose.

If you have no aches and pains by day 3 you can begin gentle-paced, low mileage runs.  Do not exceed the mileage you did the week before the marathon.  Begin every three days with light resistance training on off days.  Any aches and pains need to be addressed.  Don’t wait to see me for any pains that remain.  The sooner these are addressed the easier they are to treat.

The 2nd week and forward:

If you’ve made it this far without needing me you’re doing well.  Gradually increase run frequency and distance back to your training levels as tolerated.  You might find that you are more easily fatigued, but that is normal for the first month.  Anything more than that and you should seek medical attention.  Don’t forget to have your running shoes checked.  During this return to training period you will need to have new shoes.  At Desert Foot Surgeons we offer video gait analysis to see what the naked eye cannot.  Come have your gait analyzed in or out of shoes.

Congratulations, you did it!!