Medically reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatric Surgeon — Balance Foot & Ankle, Howell & Bloomfield Hills, MI. Last updated April 2026.

Pre-operative laboratory testing before foot and ankle surgery serves the important purpose of identifying undiagnosed medical conditions that could increase surgical risk — but routine ordering of a large panel of labs without specific clinical indication is not evidence-based and can actually cause harm through unnecessary further testing of incidental findings. Understanding which lab tests are indicated for which procedures and patient factors helps patients prepare for surgery and understand what their pre-operative evaluation is assessing.

Evidence-Based Pre-Operative Testing

Complete blood count (CBC): indicated for all major foot and ankle surgeries — baseline hemoglobin for procedures with moderate blood loss risk (calcaneal osteotomy, triple arthrodesis, flatfoot reconstruction); WBC as a baseline for patients with diabetes or immunosuppression. Basic metabolic panel (BMP): indicated for patients on diuretics, ACE inhibitors, or diabetes medications — checks kidney function (surgery affects electrolyte balance) and blood glucose. HbA1c: essential for all diabetic patients and should be within 6 weeks of surgery — HbA1c >8.0% significantly increases wound complication risk; surgery should be deferred until glycemic control improves if HbA1c is above the safe threshold. Coagulation studies (PT/INR, PTT): indicated for patients on anticoagulants (warfarin — must check INR is in therapeutic or sub-therapeutic range pre-operatively; DOACs — hold per protocol) or with suspected bleeding disorder history. Pregnancy test: indicated for all women of childbearing age undergoing general or regional anesthesia. Cardiac risk assessment (EKG, chest X-ray): for patients with significant cardiac history or multiple cardiovascular risk factors undergoing major procedures with general anesthesia — not routinely required for minor foot procedures under local anesthesia. Vitamin D level: for patients undergoing bone procedures (osteotomies, fusions) — vitamin D deficiency significantly impairs bone healing; supplement to 25-OH vitamin D level >30 ng/mL pre-operatively. Dr. Biernacki at Balance Foot & Ankle orders individualized pre-operative labs based on the procedure and patient health status to ensure surgical safety. Call (810) 206-1402 at our Bloomfield Hills or Howell office for surgical consultation.

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Frequently Asked Questions

How do I know if I sprained or broke my ankle?

Both cause pain, swelling, and difficulty walking. Key differences: fractures often cause more immediate severe pain, tenderness directly over bone (not just ligament), and inability to bear any weight. X-rays and the Ottawa Ankle Rules help determine if imaging is needed.

How long does an ankle sprain take to heal?

Grade I (mild): 1–2 weeks. Grade II (moderate): 3–6 weeks. Grade III (complete tear): 2–3 months. Chronic instability from improperly treated sprains can persist and may require surgery.

What is the best treatment for a sprained ankle?

RICE protocol (Rest, Ice, Compression, Elevation) for the first 48–72 hours, followed by protected weight-bearing as tolerated. Physical therapy rehabilitation is critical for high-grade sprains to restore strength and proprioception and prevent chronic instability.

Need Treatment at Balance Foot & Ankle?

Dr. Tom Biernacki, Dr. Carl Jay, and Dr. Daria Gutkin see patients at our Howell and Bloomfield Township offices.

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Preparing for Foot & Ankle Surgery in Michigan

Proper preoperative evaluation ensures the safest possible surgical outcome. Our team coordinates all necessary lab work, medical clearances, and pre-surgical planning to prepare you thoroughly for your foot or ankle procedure.

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Clinical References

1. Bock M, Johansson T, Fritsch G, et al. The impact of preoperative testing for blood glucose concentration and haemoglobin A1c on mortality, changes in management and complications in noncardiac elective surgery. Eur J Anaesthesiol. 2015;32(3):152-159.
2. Fleisher LA, Fleischmann KE, Auerbach AD, et al. 2014 ACC/AHA guideline on perioperative cardiovascular evaluation. Circulation. 2014;130(24):e278-e333.
3. Whinney C. Perioperative medication management: general principles and practical applications. Cleve Clin J Med. 2009;76(Suppl 4):S126-S132.

Your Board-Certified Podiatrists

Dr. Tom Biernacki, DPM

Board-Certified · FACFAS

Dr. Carl Jay, DPM

Board-Certified Podiatrist

Dr. Daria Gutkin, DPM

Podiatrist

Dr. Tom Biernacki, DPM

Dr. Tom Biernacki, DPM is a double board-certified podiatrist and foot & ankle surgeon at Balance Foot & Ankle Specialists in Southeast Michigan. With over a decade of clinical experience, he specializes in heel pain, bunions, diabetic foot care, sports injuries, and minimally invasive surgery. Dr. Biernacki is a member of the APMA and ACFAS, and his patient education content on MichiganFootDoctors.com and YouTube has reached over one million views.