Preparing for Ankle Surgery
What to do between “you need surgery” and being wheeled into the OR.
How much time you have to prepare for ankle surgery can vary enormously. A planned procedure may give you days or weeks to get your home, equipment and help lined up. An acute injury may leave you already nonweightbearing, headed to surgery almost immediately or waiting for swelling to subside—with much of your new reality already cobbled together on the fly.
Wherever you are in that process, there are still things you can do to make the first days after surgery easier. If you've already been managing on one leg for a week, some of this may sound familiar. Consider that a head start.
Before Surgery
This is the time to get your logistics straight. Know when and where you're supposed to arrive, who’s taking you, and whether you're expected to go home the same day.
Make sure your surgical team has a complete list of your medications, vitamins and supplements. Some may need to be stopped before surgery; others may need to be continued, including on the morning of surgery.
The same goes for eating and drinking before anesthesia. The rules aren't necessarily the old blanket “nothing after midnight,” so make sure you know exactly when you need to stop eating and what, if anything, you're allowed to drink.
WORTH KNOWING
For both my ankle surgeries I was allowed to drink clear liquids—which thankfully included coffee, in spite of its tint—until two hours before my arrival at the hospital. If you're given similar instructions, clear liquids can help you stay hydrated, and apple or white grape juice can provide some carbohydrates.
The Recovery Timeline
One of the things most of us want to know before surgery is how long we're going to be laid up.
There may actually be several answers. How long will you be completely nonweightbearing? When might you be allowed to walk in a boot? When could physical therapy start? What about driving, going back to work or returning to whatever you did before you broke the thing?
(Personally, life became tolerable again when I was allowed to start weightbearing. We can put a happy face on it, but life on one leg is difficult.)
It's worth having a general timeline in your head, but don't get too attached to it. What your surgeon expects before surgery and what you actually need afterward aren't always identical.
Imaging can show a great deal, but it doesn't necessarily reveal every injured structure. Sometimes additional ligament, cartilage or tendon damage becomes apparent during surgery, or a repair turns out to be more extensive than expected. That can change weightbearing restrictions, rehabilitation and the overall recovery timeline.
MY TAKE ON IT
That happened to me. I went in for ORIF surgery with the expectation that I’d be allowed to start weightbearing as tolerated two weeks later. During the operation, my surgeon discovered a ruptured peroneal tendon and repaired that, too. After the operation, she came into my recovery room to tell me that the plan had changed, and that due to the severity of my soft tissue injury, it would be six weeks—not two—of nonweight-bearing.
That doesn't mean you should expect a surprise. It does mean that any recovery timeline you hear beforehand is based on what your surgeon knows beforehand.
Beyond the Ride Home
You'll almost certainly need someone to drive you home after anesthesia. But think beyond the ride.
How are you getting from the car into the house? Are there steps? Can you get to the bathroom? Where are you going to sleep? Who can pick up a prescription or bring you something you forgot?
If you haven't already been nonweightbearing, try out whatever mobility device you're likely to use. Crutches, walkers and knee scooters all have their own peculiarities, and discovering them while you're still clearheaded is preferable to discovering them just after surgery.
Practice the routes that matter: bed to bathroom, chair to kitchen, through narrow doorways and up or down any unavoidable steps.
For much more on choosing and using equipment, see Mobility Tools After an Ankle Fracture.
Your Little Kingdom
Choose where you're going to spend most of your time for the first few days and set it up before you leave for surgery.
You'll want a comfortable way to elevate your leg and the usual necessities within reach—water, medications, phone, charger, tissues, remotes and whatever else you don't want to make a trip across the room to retrieve.
Clear the path to the bathroom. Throw rugs, electrical cords and clutter are a different proposition on one leg.
The bathroom itself deserves some attention. A shower chair, grab bars or toilet safety rails may be useful depending on your situation. Even if you're already getting around reasonably well, remember that you'll be coming home with a freshly operated ankle, possibly a nerve block and probably a splint or substantial dressing.
For more ideas about setting up your home, see Ankle Fracture Recovery Essentials.
Get Ahead of the Meds
If your surgeon gives you postoperative prescriptions ahead of time, fill them before surgery. It’s not fun to discover that the pharmacy is closed, your medication isn't in stock or your insurance requires authorization.
Know what the pain-control plan is before you go home. If an opioid will be part of it, constipation prevention is worth thinking about from the beginning.
Rather than going into all of that here, see Pain Management During Recovery and Constipation After Surgery.
Eat and be Merry
Have some easy food and drinks available for the first few days. If you'll be alone for stretches, think about how you're going to transport them while using your mobility device. A backpack or crossbody bag can be useful, as can anything with a lid that doesn't leak.
For the longer haul, see Healthy Eating for Ankle Fracture Recovery.
Dress for the Occasion
Wear something loose to the hospital or surgery center. Your operated leg is likely to come home considerably bulkier than it went in, thanks to a splint, cast or dressing. Shorts, sweatpants or wide-legged pants are convenient. And you'll want a stable shoe for your good foot.
Keep in mind these types of duds are what you’ll likely be wearing for at least a couple of weeks. Suffice to say your skinny jeans are unlikely to be seeing much action anytime soon.
If You're Having a Nerve Block
A nerve block can make the first hours after surgery surprisingly comfortable. It can also wear off rather dramatically.
Know approximately how long yours is expected to last and, more importantly, when you're supposed to begin your oral pain medication. You don't want to be figuring out the plan for the first time as sensation comes roaring back.
There's much more about this in the Pain Management Chapter under Nerve Blocks for Surgical Pain.
The First Night
Before you leave for surgery, know where you're going to sleep and how you're going to get there.
Put your medications and discharge instructions somewhere easy to find. Charge your phone. Have water nearby. If you're responsible for children, pets, horses or another person, arrange for someone else to handle them.
I strongly recommend you have someone stay with you for at least a day or two.
ASK YOUR SURGEON
You don't need to show up with three pages of questions (like me), but there are some answers worth having before surgery:
What exactly are you planning to repair?
Is there anything else you suspect may be injured?
How long do you expect me to be nonweightbearing, and what might you find or need to do during surgery that could change that?
What will I wake up in—a splint, cast or boot?
When do you expect me to begin weightbearing and physical therapy?
Will I have a nerve block, and when should I begin oral pain medication?
What symptoms after surgery mean I should call you or seek urgent care?
When is my first follow-up?
If returning to something specific matters to you—work, driving, running, riding, skiing—ask about that.
Write down the answers, or have whoever is with you do it.
The time between “you need surgery” and actually having it can be hours, days or weeks. You can't prepare for every possibility, and you can't control what your surgeon finds once the operation begins.
But you can make sure home is ready when you get back.