Handouts

• Steriod Injection

  Corticosteroid Injections for Foot & Ankle Conditions

  What Are Corticosteroid Injections?
  Corticosteroid injections, often referred to as “steroid injections,” are commonly used to reduce inflammation and relieve pain in various foot and ankle conditions. The medication contains a corticosteroid (a type of anti-inflammatory drug) and a local anesthetic. The corticosteroid helps decrease inflammation in the treated area, while the anaesthetic provides immediate but temporary pain relief.

  Why inject steroids?
  Steroids act as an anti-inflammatory. These are not the same as anabolic steroids used by body builders to increase muscle size and strength. Steroid injections are often recommended to people with arthritis or inflammatory soft tissue conditions such as arthritis, bursitis, nerve pain, tendinitis etc.

  Common Conditions Treated with Corticosteroid Injections:
  Corticosteroid injections are often recommended for the following foot & ankle conditions:
  Plantar fasciitis: Inflammation of the thick band of tissue connecting your heel to the base of your toes.
  Arthritis: Chronic inflammation in the foot and ankle joints.
  Achilles tendonitis: Inflammation of the Achilles tendon.
  Morton’s neuroma: Nerve pain between the toes, often caused by thickened tissue around a nerve.
  Bursitis: Inflammation of fluid-filled sacs in the foot or ankle.
  Plantar fibromatosis: Formation of nodules or fibrous tissue within the plantar fascia (the sole of the foot), which can cause pain and discomfort.
  Ganglion cyst: Fluid-filled sacs that can develop along tendons or joints, often appearing as lumps on the top of the foot or ankle.

  Benefits of Corticosteroid Injections:
  Pain Relief: Corticosteroids reduce inflammation, which can lead to significant pain relief.
  Improved Mobility: Reducing pain and swelling often allows for improved movement in the affected area.
  Fast-Acting: Most patients experience relief within a few days, though some feel relief almost immediately due to the anesthetic.

  How long does it take to work?
  Some steroid injections start working within hours and last a couple of weeks whereas some other steroids may take up to a week to become effective but can ease pain for three months or longer.

  Can I take other medications along with steroid injections?
  Yes, you can take other medications with steroid injections.

  Fertility, pregnancy, and breastfeeding.
  Current guidelines say that steroids are not harmful in pregnancy or breastfeeding. However, if you are pregnant or breastfeeding, you should discuss this with Dr. Kim before having a steroid injection.

  Important Considerations:
  Frequency of Injections: Generally, injections are limited to 3-4 times per year per site to reduce the risk of tendon or joint damage.
  Pain Relief Duration: Relief duration varies. Some patients experience relief for several weeks, while others have longer-lasting effects up to 3-6 months.
  Follow-up Treatments: In some cases, additional therapies like physical therapy or orthotics may be recommended for long-term management.

  Possible Side Effects:
  While corticosteroid injections are generally safe, potential side effects include:
  • Temporary pain or swelling in the treated area.
  • Skin thinning or discoloration at the injection site.
  • Infection at the injection site (though rare).
  • Weakened tendons (especially with frequent injections in the same area).

  What to Expect During the Procedure:
  Preparation: The skin is cleaned thoroughly, & a numbing spray or cream may be applied.
  Injection: Using a fine needle, the corticosteroid and anesthetic mixture is injected into the targeted area under ultrasound guidance. You might feel slight pressure or discomfort.
  Aftercare: You’ll likely be asked to rest the area for 24 hours. Avoid heavy or repetitive activities for a few days.

  Post Injection Care:
  Immediately after surgery:
  The numbing medication usually wears off in 3 to 4 hours. After it wears off, you may feel some soreness in injected areas. The soreness may last for up to 48 hours until the steroid medication starts to work. If you feel sore, using a cold pack may help. Hold the cold pack for no more than 10 minutes, then remove it for 10 minutes. You can do this several times a day, as needed.

  Don’t use cold packs if you have:
  o Problems with blood supply, such as Raynaud’s Disease
  o Problems related to poor circulation
  o Nerve problems with poor sensation
  Keep a dry and clean bandage or Band-Aid® over the injection site for 24 hours.

  Driving – You are able to drive immediately after the injection
  Return to Work – You are able to return to work immediately after the injection
  Low impact exercise – try to limit activities on the day
  High impact exercise – limit high impact exercises for 2-3 days

  When to Contact Us:
  After the injection, contact us if you experience:
  • Significant redness, warmth, or increased pain at the injection site
  • Fever or chills
  • Any new or unusual symptoms

  Discussing Options and Making the Decision:
  Corticosteroid injections can be highly effective, but they may not be suitable for everyone. We will evaluate your specific condition and overall health to determine if this treatment is appropriate.

• Ingrown Toenail Post-Op Instructions (Phenolisation Procedure)

  

   

  Ingrown Toenail Post-Op Instructions (Partial Nail Avulsion with Phenolisation)

  The following should be adhered to in order to hasten your recovery from foot surgery.

  Rest
  When you get home lie down and place your feet above your heart until the local anaesthetic wears off. This will prevent the throbbing pain that tends to occur when individuals walk around and continue to engage in activities while numbed up and the agent wears off.

  Numbing agent will wear off in 3-4 hours — feel free to take Panadol as needed for pain management.
  You may experience post-surgery bleeding — this is normal. Do not remove the bandage or dressing, instead place additional dressing over toe.

  Care
  Keep your foot clean & dry until the next morning then:

  • Soak your foot/feet with bandage on, for 10 minutes, 1-2 times a day (you may take a shower as well, if you feel your toes can handle the pressure of the water hitting your toes.)
  • Dissolve 1 tbsp. of Table salt or Epsom salt per pint of warm water.
  • Gently remove bandage(s) after soaking and pat dry softly before applying Betadine (ointment or liquid) into the groove where the nail previously existed.
  • Place a new bandage/dressing on wound and repeat for 7 days until your first post-op appointment.

  You may experience drainage (body waste and chemical solution) from the wound, and this is normal as the body expels the root cells in the nail matrix that were killed with the chemical acid for 2-4 weeks.  Redness around surgical area is normal unless it increases dramatically.

  Contact Dr Kim if

  • You experience excessive pain or see signs of infection such as an extended redness
  • You see a presence of pus
  • You have excessive swelling and pain

  Email photos of your foot to info@footsurgery.com.au

• Ingrown Toenail Post-Op Instructions (Winograd Procedure)

  

   

  Ingrown Toenail Post-Op Instructions (Winograd Procedure)

  The following should be adhered to in order to hasten your recovery from foot surgery.

  Medications
  Antibiotics. Take as directed until completed to reduce risk of infection. In case of abdominal discomfort, take acidophilus tablets with each dose of antibiotic to reduce symptoms. Should you experience any adverse reaction to the antibiotics, please stop taking them and call Dr Kim immediately.
  Analgesics. Take pain medication only if you need to with some food to reduce the risk of nausea.

  Rest
  When you get home lie down and place your feet above your heart until the local anaesthetic wears off. This will prevent the throbbing pain that tends to occur when individuals walk around and continue to engage in activities while numbed up and the agent wears off.

  Numbing agent will wear off between 8-12 hours — feel free to take Panadol, as needed for pain management.
  You may experience post-surgery bleeding — this is normal. Do not remove bandage or dressing and instead place additional dressing over toe.

  Care
  Keep your foot clean and dry until your follow-up appointment. Your suture is usually removed during your follow-up appointment between 7-10 days post-surgery.
  Until suture removal, you are required to keep your foot clean and dry.

  Contact Dr Kim if

  • You experience excessive pain or see signs of infection such as an extended redness
  • You see a presence of pus
  • You have excessive swelling and pain

  Email photos of your foot to info@footsurgery.com.au

• Plantar Wart Post-Op Instructions

  

   

  Plantar Wart Post-Op Instructions

  The following should be adhered to in order to hasten your recovery from foot surgery.

  • Go home immediately after the procedure and stay off your foot as much as possible for a couple days.
  • Keep the foot elevated above your heart.
  • The anaesthetics will typically wear off in 4 to 8 hours after the surgery.
  • Assuming that pain medication is needed, use either the medication prescribed by your surgeon or 2 Ibuprofen approximately 3 hours after the procedure is performed.
  • Wart excisions tend to bleed a lot. So, a small amount of bleeding and drainage (roughly 3-4 cm in diameter) oozing into your dressing is normal post-operatively. It should not be actively expanding though, and it should be pretty much dry by the next day. If significant bleeding occurs, please call the office.
  • Do not remove the dressing applied until 2-3 days as instructed by your surgeon. After removing the dressing soak the foot in Betadine solution and lukewarm water (seven capfuls of Betadine to 1 litre of water) for twenty minutes. You are to soak your foot each day until your first post-operative visit.
  • Keep the foot dry until the first dressing change. Following your foot soaks, you will apply topical antiseptics such as Betadine and a clean dressing 2-3 times a day.
  • Try to keep the dressing clean and dry when showering. After a shower, change your dressing immediately.
  • If the foot gets wet accidentally, you may remove the dressing, apply an antiseptic cream or ointment and a sterile dressing.
  • Healing time varies depending on the wart size.

  Contact Dr Kim if

  1. You notice excessive bleeding
  2. You develop a fever
  3. You have any questions

  Email photos of your foot to info@footsurgery.com.au

• Minor Procedure Post-Op Instructions

  

   

  Minor Procedure Post-Op Instructions

  The following should be adhered to in order to hasten your recovery from foot surgery.

  Medications
  Antibiotics. If needed, take as directed until completed to reduce risk of infection. In case of abdominal discomfort, take acidophilus tablets with each dose of antibiotic to reduce symptoms. Should you experience any adverse reaction to the antibiotics, please stop taking and call Dr Kim immediately.
  Analgesics. Take pain medication only if you need to with some food to reduce the risk of nausea.
  Anti-inflammatories. Take these if you are directed to. As with analgesics, have some food at the same time to reduce the risk of nausea.

  Rest
  When you are resting, keep your operated foot elevated. To reduce the risk of blood clots in your legs (DVT), exercise your leg muscle by rotating your ankles and flexing and extending your knees at regular intervals. Walking is permitted and encouraged, as tolerated.

  Bandages
  Bandages must be kept dry at all times and must not be removed before your first post-operative consultation with Dr Kim. Wear post-operative shoes all the time, even at bed for the first 2 weeks.
  Place a plastic bag over your foot when showering.

  Contact Dr Kim if

  • You experience severe pain that is not relieved by rest, elevation, pain medication and/or applying an ice pack to the operated part.
  • Your bandages become saturated with blood.
  • The colour of your toes appear abnormal (some bruising is normal and usually appears after a day or two).

  Email photos of your foot to info@footsurgery.com.au