Foot and ankle surgery — whether for a bunion, hammertoe, plantar fasciitis, Achilles tendon repair, or ankle arthrodesis — raises the same fundamental questions for virtually every patient: What happens before surgery? Will I be under general anesthesia? When can I walk? How do I prepare my home? Getting clear answers to these questions reduces anxiety, improves pre-operative compliance, and leads to better outcomes.

Pre-Operative Evaluation

Most elective foot and ankle procedures require a pre-operative evaluation including:

• Medical clearance: For patients over 50 or with significant medical history (diabetes, cardiovascular disease, respiratory conditions), pre-operative clearance from the primary care physician or relevant specialist is required. This typically includes a review of current medications, an EKG, basic laboratory work, and a general medical assessment.
• Medication management: Blood thinners (warfarin, apixaban, rivaroxaban, clopidogrel) require specific management plans — some are stopped before surgery, others are bridged with low-molecular-weight heparin. Aspirin management varies by procedure risk. NSAIDs should be stopped 7–10 days before surgery. Diabetic medications may require adjustment around the day of surgery.
• Imaging: Weight-bearing X-rays are standard; CT or MRI may be ordered for complex cases requiring surgical planning.
• Pre-operative instructions: NPO (nothing by mouth) status — typically no food after midnight for morning cases, and a light meal before midnight for afternoon cases. Showering with antibacterial soap the night before and morning of surgery.

Anesthesia Options for Foot and Ankle Surgery

Foot and ankle procedures are uniquely amenable to regional anesthesia — nerve blocks that anesthetize the foot and ankle without requiring general anesthesia. Options include:

• Ankle block: A combination of 4–5 nerve blocks around the ankle, performed in the pre-operative area under ultrasound guidance, anesthetizing the entire foot. Most outpatient foot procedures can be performed under ankle block with light intravenous sedation.
• Popliteal sciatic nerve block: A single injection behind the knee that anesthetizes the entire foot and lower leg — particularly useful for more extensive procedures. Provides 12–24 hours of post-operative analgesia.
• Spinal anesthesia: Injection into the spinal canal producing lower body anesthesia — used for longer procedures or when the surgical team prefers.
• General anesthesia: Standard general anesthesia is used when regional techniques are insufficient or contraindicated. Modern general anesthetics are very well tolerated.

Regional blocks are strongly preferred when feasible — they provide excellent intraoperative anesthesia, reduce anesthetic drug requirements, and provide extended post-operative pain control that dramatically reduces opioid requirements in the immediate recovery period.

The Day of Surgery

Check in at the surgery center 1–2 hours before the scheduled procedure. Pre-operative nursing team places an IV, reviews medications and allergies, and applies monitoring. The anesthesiologist or CRNA performs pre-operative assessment and places any nerve blocks. The surgical site is marked. Procedure time for most outpatient foot procedures is 30–90 minutes. Recovery room stay is 1–2 hours after general anesthesia; regional anesthesia patients are often discharged sooner. A responsible adult must drive the patient home and stay overnight.

Preparing Your Home Before Surgery

• Set up a recovery station on the main floor — avoid stairs if non-weight-bearing
• Place frequently needed items (medications, phone charger, remote, water) within arm’s reach
• Arrange a raised toilet seat if bathroom access is challenging
• Prepare meals in advance or arrange food delivery
• Confirm post-operative transportation and overnight support
• Fill prescriptions before surgery day

Post-Operative Recovery Expectations

Weight-bearing status varies by procedure. Many forefoot procedures (bunionectomy, hammertoe correction) allow immediate weight-bearing in a surgical shoe. Hindfoot and ankle procedures often require non-weight-bearing with crutches or a knee scooter for 4–8 weeks. Ice, elevation above heart level, and compression are universal post-operative instructions that dramatically reduce swelling and pain. The first post-operative appointment is typically at 1–2 weeks for suture/dressing check and wound inspection.