Rolando Melendez protocols for surgery when you need foot and/or ankle surgery? post operative period

1. Forefoot procedure:
 1st-3rd week: limited and protected WB with a surgical shoe, (coach-bathroom-bed),
Rest, elevate, ice (20min in, 20min out), anti-inflammatory
 4th week: Begin ROM exercises
 3rd-6th week: active WB, transfer to tennis shoe progressively
 4th week : return to sitting job,
 5-6th week: return to walking job
Rearfoot procedure
 1st week: Non weight bearing with a posterior splint
 2nd-3rd week: Non weight bearing with a cast
 4th-6th week: Weight bearing on a CAM boot
 4th week: begin PT
 6th-8th week: transfer to a tennis shoe progressively
Amputation
Indication: treatment of gangrene, acute and chronic infections,
(Digital amputation): treatment of severe painful hammertoe on compromise patients
Post-op:

digital amputation: 3 week limited and protected WB with a surgical shoe, return to job
6th week

proximal amputation 3-4weeks NWB patient will require a especial molded shoes by
the 4th week
Hammertoe repair
Indication: flexible and rigit painful digital deformities,
Deformities that can be ulcer prone in DM
Procedure:
o In-office tenotomy: flexible deformity on compromise patients
o PIPJ fusion with K-wire: 2-4 digits
o PIPIJ arthroplasty: 4-5 digits
o Skin plasty w arthroplasty: 5th digit
o MPJ capsule balancing: MPJ contracture, pre-dislocation, capsulitis
Risk: swollen digit, dorsal scar, numbness (up to 12mo)
Management of bone/joint infection:
Procedure: amputation, incision and drainage, staged procedures, use of antibiotic beads
Management of bone tumor:
Indication: prevention of malignancy spread or becoming malignant, pathological fracture
Procedure: biopsy, debridement of tumor and packed with bone chips, amputation
Metatarsal osteotomy (Weil, Jacoby):
Indication: painful IPK, pre-dislocation MPJ
Risk: transfer lesion

2. ORIF digital, metatarsal fractures:
Indication: dislocated fractures affecting the foot’s parabola
Procedure: close reduction, screw or k-wire fixation, 5th met will require 4.0-6.5 intramedullary screw, elder patient treatment can begin with a CAM boot if this fail after 4
weeks surgical treatment should be considered
Post-op: aggressive tx on atletes and young patients with PT on 3-4th week,
Ostectomy/exostectomies:
Indication: painful interdigital exostosis, subungual exostosis, dorsal midfoot
Procedure: percutaneous exostectomies
Risk: recurrence, swelling, numbness, nail change, nerve adhesions
Revision surgery:
Indication: recurrence bunion and hammertoe deformities, non-union fractures, painful
joints
Risk: longer recovery, incision complications
Post-op: longer NWB than original surgery, bone stimulator can be requiere
Bunionectomy:
Indication: painful bunion deformity in adult, progressive and severe pediatric bunion
deformity
Procedure: adult IM 12-15: Austin or Kalish, IM more than 15: base procedure, phalanx
osteotomy (Akin)
Post-op:
 Head procedure: : 3 week limited and protected WB with a surgical shoe, return
to sitting job on 4th week, return to walking job on 6th week, PT on the 4th week
 Base procedure and Lapidus: 2 weeks on a cast, 3-4th limited CAM boot, 4-5th
week sitting jobs with CAM walker, ,6th week sitting jobs with CAM walker, PT
on 4th week
Hallux limitus: painful 1st MPJ
Procedure:
 Painful joint:
 Chelectomy: painful joint no xray changes
 End stage chronic painful joint:
 Implant for older patient or non-active patients
 Fusion: active, young patient, athlete
Sesamoidectomy:
 Indication: non healing sesamoid fracture, chronic sesamoiditis
 Procedure: excision of sesamoid
 Risk: hallux valgus, hallux varus
Tailors bunion:
 Indication: Painful deformity, painful plantarflexed 5th met head
 Procedure: head osteotomy, head excision
 Risk: transfer lesion, swelling, numbness

3. Metatarsal adduction:
Procedure: multiple metatarsal osteotomies, midfoot osteotomies
Flat foot:
Procedures:
 Johnson strom 1: PTT repair, TAL
 Johnson strom 2: Kidner, calcaneal osteotomy, Evans, Cotton
 Johnson strom 3: isolated fusion
 Johnson strom 4: triple arthrodesis or pan-talar fusion
Post-op: 1st week posterior splint, 2-3rd NWB cast, 4-6th limited walking CAM walker, 68th progressive walking CAM walker
Plantar fasciitis
Indication: recalcitrant heel pain
Procedure: Topaz, EPF, Cobiguard, Open plantar fasciitis
Post-op: percutaneous procedure same postop as a forefoot surgery, open plantar
fasciitis requires longer post op recovery
Achilles tendonitis
Procedure: retrocalcaneal exostectomy, Hagland deformity excision, repair of Achilles
tendon tear (procedures require an 2-3 anchors)
Risk: dehiscence, re-rupture, tendon adhesions, nerve entrapment
Post-op: like rearfoot procedures, important physical therapy