Mr Ian Reilly FCPodS DMS

These are answers to some of the questions frequently asked by patients undergoing Podiatric Surgery.

Do I have to have an operation?

If your symptoms are mild, medication may be enough to reduce pain.  Insoles or shoe modifications may be useful for some patients.  When symptoms persist and normal ambulation is no longer possible, surgery may be necessary.

Surgery is not the answer to all foot problems. However, corrective surgical procedures can provide a solution to many long term problems that otherwise would only be treatable by chronic conservative measures.

Surgery should primarily be carried out for the relief of intractable pain or deformity; cosmesis alone can never be sufficient indication for invasive surgery.

Surgery is the treatment of choice when:

  • Other non-surgical methods of treatment are less desirable, impractical and/or unsuccessful
  • Subjective symptoms and objective findings warrant surgical intervention
  • The patient is informed of the cause, course and prognosis of the deformity, as well as the risks and ramifications of surgery

How surgery can help

  • The pain should have been reduced or may have stopped completely
  • The foot may be straighter and should function better
  • You should feel more comfortable when wearing shoes

Pre-operative assessment

As part of the examination you will be asked about your general health, your past medical history and medications taken.  The mechanism for avoidance of complications is a system of screening and investigations undertaken at various stages of your care. This includes your medical and surgical history, questions about various body systems and tests/investigations such as X-rays.

If any of these tests raises questions about the safety or appropriateness of surgery, further investigations or medical opinion may be sought.  It may be decided to avoid surgery or to defer it until the problem is treated or controlled (a typical example of this would be raised blood pressure).

What will the operation involve?

There are often several options for surgery depending on the actual deformity you have, where the pain is and your overall health status.  We will discuss which the best option for you is.  The foot will be heavily bandaged after the operation to protect the wound and control post-operative bleeding.


Like Dentists, I often perform surgery on a day-case basis under local anaesthesia – you will therefore be awake during the surgery if you elect to have local anaesthesia.  It is done using a series of injections at the toe, ankle or knee.  Using this form of anaesthesia has a lower risk than is associated with general anaesthesia.

The anaesthesia works by taking away pain but not the sensation of touch – you will not feel any pain during the operation though you will feel me touching the foot. The local anaesthetic will wear off about 3-10 hours after surgery.

General anaesthesia is easy to arrange on request (typically at the woodlands hospital).

How successful is the operation?

As with all operations there are risks associated with surgery. The mechanism for achieving a successful outcome and avoiding complications is a system of screening and investigations undertaken at various stages of your care.  The best result also requires your co-operation after surgery, based on the guidance and advice detailed below.


The possible complications associated with surgery are as follows:

  • Joint stiffness (especially following bunion surgery)
  • Recurrence or a redevelopment of the deformity
  • Infection
  • Prolonged swelling of the foot/toes
  • Delayed healing of soft tissue or bone
  • Irritation from the wire or screw (which may require later removal)
  • Loss of sensation, usually temporary but occasionally permanent
  • A thick and/or sensitive scar (very rarely, a chronic nerve pain)
  • DVT (a thrombosis or blood clot, seen only in very rare cases)

Complications themselves can usually be revised or treated and should not result in permanent disability or pain.  However, a small percentage of patients do develop long-term problems or are otherwise dissatisfied with the results of surgery.  You must therefore assure yourself that the potential benefits of surgery outweigh the risks.

In my experience, 80% of are patients are improved with surgery (though not necessarily completely cured), 10% of patients derive no benefit from surgery and 10% of patients have a post-operative complication or are otherwise disappointed with the results of surgery.

You insist that I must have someone stay with me after surgery.  Why?

This is for your own safety.  Although exceedingly rare, it is possible that you may feel unwell after surgery, or you may fall and require assistance.

My friend/relative had to stay in hospital for a number of days after their operation.  How is it possible for me to be seen as a day-case?

Your friend may not have been a suitable case for day surgery.  It is possible that he or she was unable to have someone stay with him or her at home after the operation.  Additional tests may have been required, or the operation itself was more extensive.

If I am ill before the date of my operation should I cancel?

Yes.  If you are feeling unwell near the date of your operation or if either you or a member of your household is suffering from an infectious disease you are advised to contact the hospital so that an alternative appointment can be arranged.  We may be able to offer your appointment to another patient so as much notice as possible would be appreciated.  On the day of surgery if, for example, your blood pressure has raised or you have developed other medical problems, the surgery may be delayed or postponed.

Can I eat before I come in for my operation?

Yes: if I use local anaesthetic you may have a light meal and a drink before you attend. If you are having a general anaesthetic you will not be able to eat on the day of your surgery.

What will happen after the operation?

The foot will be quite sore for the first two days and you will therefore be given painkillers on the recovery ward immediately after surgery.  You should continue to take these for the next few days as required.

If you experience an excessive amount of pain after the anaesthetic wears off, this can be helped with application of an ice pack at the ankle – 10 minutes on/10 minutes off – three times, to a maximum of six cycles in a 24 hour period.

Will I need crutches?

Usually, yes.  The post-operative shoe will allow you to bear weight immediately after surgery but many patients find that crutches are not easy to use.  Where crutches are specifically required (e.g. where walking is difficult without the use of a crutch) or requested, I will arrange for the Physiotherapist to issue you with them on the recovery ward.  Depending on your insurance cover, the Hospital may charge you directly for this service.

Instructions for the first 2 days after surgery

To assist in the avoidance of post-operative swelling I ask that you completely rest for two full days after surgery, with your foot elevated above your hip.  During this time gentle foot exercises – rolling of the ankle – should be performed to reduce swelling.  Walking should be restricted – going to the toilet and back again ONLY.  This is why I insist that someone is able to care for you during this time so that someone is able to cook for you, etc.  If you are not able to have someone stay with you we will need to postpone the date of surgery.

Please use the surgical shoe whenever you are on your feet (you may take it off in bed or when resting with your feet up).  The shoe is designed so that it does not bend; this prevents too much pressure being applied to the wound.  Walk with the foot being placed carefully on the ground with the whole of the sole contacting the floor at the same time.  You do not need to take the weight of the body on the heel alone unless you are given specific post-operative advice to do so.

After surgery, when can I have a bath?

You can have a bath any time after surgery but you must avoid getting the dressing wet as this may cause the wound to become contaminated.

I find that it is best to avoid showering though there is a range of specially designed dressing protectors (polyurethane bags) that can be used to cover the foot.

Instructions for the first 4 weeks after surgery

After two days complete rest, we expect you to be on light duties for 4 (or more) weeks, i.e. ambulating GENTLY around the house.  Wear the surgical shoe during this time whenever you are walking but please resist the temptation to walk excessively.

You may find that you experience only minimal post-operative pain; this may mislead you into thinking that you can do more than you should.

You will attend for suture removal and re-dressing after 10-14 days and another appointment will have been scheduled for 4-6 weeks after surgery, which may involve X-rays.  You can get the wound wet only AFTER the dressings have been finally removed, i.e. when the skin has fully healed (typically 4/6 weeks).  This is to prevent wound contamination.

The recovery period from surgery will vary depending on the specific procedure performed and your body’s healing rate.  Most patients take 6 months to fully recover from their operation.

Week 4 to Week 26

Over the 4 to 6 weeks after the surgery the foot starts to return to normal and you should be back to more normal footwear.  Although the foot should now be more comfortable, there will still be noticeable swelling, particularly towards the end of the day and therefore use of wider shoes or trainers is often required.  This is normal as feet and legs are very prone to swelling.  A review appointment will be scheduled for 6 months after your surgery.

After 6 months the residual swelling should now be slight, if not completely resolved, and you should be getting the full benefit of the surgery.  I will give you specific advice as he assesses your rate of healing in the post-operative period.

Should I worry about contracting MRSA?

None of my patients have ever contracted MRSA.

Control of Infection

Podiatric surgery is carried out under strict infection control guidelines using full theatre (aseptic) technique. Part of our precautions includes screening for MRSA. You will also be given a small dose of antibiotics immediately before surgery if we insert any implant or prosthesis to help reduce the risk of developing an infection after surgery. Please ensure that you take a bath or shower using normal soap on the day of your surgery.

It is very important that you keep your dressing dry after surgery, as wet dressings will often case wound infection. Contact us immediately if you do get the dressing wet, as you will need a change of dressing. We will inspect your wound after surgery and inform you if you need further antibiotics but you must also let us know if any of the following occur as they may indicate a developing infection:

  1. An increase in pain 4-5 days after surgery
  2. A discharge through the dressing (other than iodine or a small amount of blood)
  3. An offensive odour

When can I drive a car?

You will not be able to drive on the day of the operation.  You are strongly advised not to drive whilst the sutures are in or while you are still wearing the post-operative shoe, i.e. for the first 4-6 weeks.

When can I return to work?

Most patients can normally return to work 4-6 weeks after surgery.  Obviously it will depend on the type of work you do as well as the nature of the surgery.  If you have a physically active job you may be advised to take more time off than if you worked in an office.  Although the skin heals relatively quickly, it takes many months for all the bones and tendons to return to full strength.  Also remember it is possible for the foot to remain sore and swollen for some time.

If you require a “sick note” you will be able to obtain this from your own family doctor.  I will write to your GP to keep them informed if your progress.

What is a Podiatric Surgeon?  Are you doctors?

A Podiatric Surgeon is a specialist in the treatment of foot problems by both surgical and non-surgical methods. Podiatric surgeons qualify as Podiatrists initially and then train for at least a further 5 years in the surgical management of foot problems. Podiatric Surgeons, like Dental Surgeons, are not Registered Medical Practitioners. They have specialised throughout their training in the treatment of one area of the body, i.e. the foot.

Members of the UK Society of Chiropodists and Podiatrists wishing to train in Podiatric Surgery follow a comprehensive post-graduate syllabus and are examined in all aspects of theoretical and practical surgery to gain fellowship status. Our scope of practice is “surgery of the foot and related structures”.

These are answers to some of the questions frequently asked by patients undergoing Steroid Injections.

How quickly will the injection work?

This varies with individuals but most people report improvement of their symptoms within 24-48 hours. It can, however, take a few days before any change is noticed and some patients gain little if any benefit from their use.

How long will the effects last?

Improvement can last for weeks or months, and in some cases improvements last even longer.

Do i need to rest after the injection.

You should try and rest for the first 2-3 days after the injection and avoid any activities that normally make your symptoms worse. This will help the steroid work.

Are there any side effects?

Side effects from the low doses used in injections are rare but can occur. The most common are:
A steroid “flare” – pain at the injection site. This happens in 10% of patients. The pain can be quite severe but settles down in a day or two. Take over-the-counter painkillers if required, such as paracetamol.

  • Facial flushing – this may occur 24-48 hours after the injection, but will settle within a day or two.
  • Fat wasting – a small amount of sub-cutaneous fat may be affected by the injection leaving an indentation at the injection site.

Please ask if you have any further questions regarding your surgical care.