Transcript Care of the Post-Op Foot Surgery Patient

Care of the Post-Op
Foot Surgery Patient
By Anne Eby, RN, ONC, BSN
Nursing made Incredibly Easy!
November/December 2008
2.0 ANCC/AACN contact hours
Online: www.nursingcenter.com
© 2008 by Lippincott Williams & Wilkins. All world rights
reserved.
Foot Surgery
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Includes a variety of procedures:
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Removal of a growth
Amputation of part or all of the foot
Elective or emergent procedures for
musculoskeletal disorders
Nonsurgical management remains the treatment
of choice for chronic foot disorders
When these options fail, surgical treatment may
be necessary
Anatomy of the Foot
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The foot contains:
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26 bones
33 joints
More than 100 ligaments, tendons, and muscles
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Joints and muscles of the foot allow for a wide
range of motion
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Components prone to injury:
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Achilles tendon
Plantar fascia ligament
Two most commonly discussed arteries:
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Dorsalis pedis
Posterior tibial
Anatomy of the Foot
Common Foot Deformities
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Bunions—a local painful swelling caused by
misalignment of a joint
Clawfoot—an abnormally high arch and a fixed
equinus deformity of the forefoot; Charcot foot
deformity is a common cause
Clubfoot—one or both of the feet turn inward;
effects 1 in 1,000 newborns
Flatfoot—progressive disorder in which the arch
of the foot is diminished; four times more likely in
women; causes: congenital abnormalities, injury,
muscle fatigue, obesity, hypertension, diabetes,
or arthritis
Common Foot Deformities
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Hammer toe—flexion deformity of the
interphalangeal joint
Heel pain—usually related to inflammation of the
plantar fascia or entrapment of the medial
calcaneal nerve or the first branch of the lateral
plantar nerve
Morton’s neuroma—swelling of the third branch
of the median plantar nerve caused by ischemia
of the nerve from compression or trauma
Picturing Common
Foot Deformities
A Closer Look at Charcot foot
Treatment
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Bunions
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Clawfoot
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X-rays to determine the extent of deformity
Ranges from no treatment to orthoses or night
splints
Exercises and bracing
Clubfoot
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Managed exclusively with the Ponseti technique,
which involves stretching the foot, casting, and
tenotomy, followed by wearing braces
Treatment
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Flatfoot
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Hammer toe
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Wearing open-toed sandals and performing
manipulation exercises; osteotomy may be required
Heel pain
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Exercises and orthoses, surgery if necessary
Corticosteroid injections, taping ,and casting;
surgery when conservative treatment fails after 6 to
12 months
Morton’s neuroma
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Inner soles and metatarsal pads to balance foot
posture, local hydrocortisone injections
Post-Operative Care
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Depends on type of injury and procedure
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Nursing care focuses on:
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Promoting tissue perfusion
Pain management
Preventing complications
Improving mobility
Promoting Tissue Perfusion
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Assess the neurovascular status of the affected
extremity every 1 to 2 hours for the first 24
hours, including:
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Color
Edema
Temperature
Pain
Capillary refill time
Sensation
Pulses
Motion
Indicators of Neurovascular
Dysfunction
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Circulation
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Motion
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Pale, cyanotic, or mottled color
Cool temperature
Capillary refill time of more than 3 seconds
Weakness
Paralysis
Sensation
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Paresthesia
Unrelenting pain
Pain on passive stretch
Absence of feeling
Pain Management
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Related to inflammation
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Elevation and ice
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Oral or I.V. pain medications
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Assess your patient’s pain by asking her to
identify its location, describe its quality, and rate
its intensity
Preventing Complications
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Most significant are infection and deep vein
thrombosis
Prophylactic antibiotics
Pin care (if applicable) with stringent standard
precautions
Early mobilization, compression devices, and
anticoagulants as appropriate
Improving Mobility
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Weight bearing as tolerated/ordered
Use of assistive devices, such as crutches or a
walker
Patient teaching in safe use of these devices
Teaching Crutch
Maneuvering Techniques
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To sit down
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Grasp the crutches at the hand pieces for control
Bend forward slightly while assuming a sitting
position
Place your affected leg forward to prevent weigh
bearing and flexion
To stand up
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Move forward to the edge of the chair with your
strong leg slightly under the seat
Place both crutches in your hand on the side of the
affected leg
Push down on the hand piece while raising your
body to a standing position
Teaching Crutch
Maneuvering Techniques
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To go down stairs
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Walk forward as far as possible on the step
Advance the crutches to the lower step, advancing
your weaker leg first and then the stronger one
To go up stairs
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Advance your stronger leg first up to the next step.
Advance the crutches and then the affected leg
A helpful memory device for your patient is: Up with
the good, down with the bad
Tripod Position for the
Basic Crutch Stance
Self Care After Foot Surgery
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Signs and symptoms
to report
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Elevate your foot to
heart level
Apply ice as prescribed
Use analgesics as
prescribed
Report unrelieved pain
Mobility
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Change in sensation
Inability to move your
toes
Toes or foot cool to the
touch
Color changes
Pain management
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Use assistive devices
safely
Comply with prescribed
weight-bearing limits
Wear a special
protective shoe over the
dressing
Wound care
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Keep the dressing or
cast clean and dry
Report signs of
infection, such as pain,
drainage, or fever,
immediately
Follow the prescribed
antibiotic regimen
Keep your appointment
with the surgeon for the
initial dressing change