Post-operative exercises following podiatric surgery: A guide for patients

It is not uncommon for your big toe to be stiff after surgery, so you will need to exercise the joint to get the movement back. Follow these instructions carefully and carry out the exercises recommended. If you are unsure of any advice, or unable to do them, please contact the Podiatric Surgery Service.

Immediately following big toe surgery

Despite being painful you should try to wiggle your big toe for a few minutes every hour

Between three to four days and two weeks

Now the majority of post-operative pain has subsided, you can start to put gentle weight on your foot more regularly. Place your heel on the ground first then gently put weight on the ball of the foot, spreading the weight across the sole of the foot. Do not push off the toes; instead lift the foot off the floor as though you were stepping over a broom.

Walk slowly, little but often and keep wriggling the toe.

Following stitch and dressing removal (usually at two weeks after surgery).

Footwear

Use a roomy shoe such as a trainer or plimsoll type.

You may need to obtain a larger size than normal to accommodate the swelling of your foot

The shoe will probably feel tight and a little sore compared to the post operative shoe, but this will actually help reduce the swelling.

Walking

You can now increase your walking activities with care, gently starting to roll off the ball of the foot.

It is normal at this early stage for this to feel a little stiff and uncomfortable.

Your foot will be more swollen at the end of the day, or following long periods of standing. This swelling normally takes many months to disappear completely.

If your foot or toe(s) become very swollen and painful, you have probably been overdoing it, so rest the foot up at hip level and use ice packs.

During the next couple of weeks, try to concentrate on walking as normally as possible (being guided by the comfort of your foot), ensuring walking is slower and gentler than normal.

When sitting or resting still put your foot up, level with your hip.

Joint exercises

Manually assisted range of motion exercises and theraband exercises are recommended.

Manually assisted range of motion exercise

• Start moving the big toe joint upwards and downwards using your fingers
• Move the toe to the point where it is uncomfortable, then push a little more. It may be difficult to do this yourself so you may need someone to do this for you
• Gradually increase force each day as tolerated
• Do this exercise for at least five minutes, a minimum of four times a day
• It is normal for this exercise to be mildly painful, remember that you are doing the joint good and it will help towards getting the full movement in the toe back
• Extreme pain means you are pushing too hard.

Theraband exercises

You might have been given a piece of elastic (a theraband).

• Sit with your foot at 90 degrees to your leg
• Place the centre of the band under the toe that has been operated on
• Keep hold of the two ends
• Pull the band tight so that it starts to pull the toe towards you
• Keeping the band taut, push your toe away from you against the band 15 times
• Increase the tension of the band and repeat the toe pushes 10 times
• Finally, increase the tension further and push the toe away from you five times, then relax
• Repeat at least three times a day.

Please note: It is important to push your big toe down against the band and not pull the toe toward you. The movement should be of the big toe joint, not your ankle or arm.

Partial weight bearing exercises

These can start four weeks after surgery.

• Stand facing a wall
• Place your recovering foot one step backwards, and steady yourself with your hands on the wall
• Lift the heel of your recovering foot off the ground while keeping the big toe flat on the floor
• Stop at the point of discomfort, and push down through your big toe on the ground
• Hold for 10 seconds then relax. Continue for five minutes and repeat three times a day.

In order to recover as much movement as possible in the big toe joint, it is necessary to push to the limit of your joint. This will be uncomfortable and will make the joint ache for a short while after exercising. In such instances, utilise rest/elevation together with the use of ice packs and anti-inflammatory gel/medication.

You should aim to continue these exercises for at least 12 weeks or until you have been able to return to normal footwear and activities.

It is important to remember that a small number of people who have had surgery on the big toe joint never get all the movement back in the joint, and that postoperative swelling can persist for six months or longer after surgery.

This may have no adverse consequences for day-to-day activities, but can affect the ability to wear tight shoes or fashionable women’s shoes. However you will greatly increase your chances of a successful result if you follow these instructions carefully.