What are the discharge instructions and outpatient physical therapy (PT) instructions for a patient with a compound foot fracture after surgery?

Discharge Instructions and Outpatient Physical Therapy for Compound Foot Fracture Patients

For patients with compound foot fractures after surgery, discharge instructions should include pain management with acetaminophen as the primary analgesic, weight-bearing restrictions based on fracture stability, wound care instructions, and a structured rehabilitation program with outpatient physical therapy focusing on progressive mobility and strengthening exercises. 1, 2

Discharge Medication Instructions

• Pain Management:

  • Regular acetaminophen (1000mg every 6 hours) should be the mainstay for pain relief 3
  • Avoid opioids when possible due to risk of side effects, particularly in patients with renal dysfunction 1
  • Avoid NSAIDs, especially in patients with renal dysfunction 1

• Thromboprophylaxis:

  • Continue prescribed thromboprophylaxis for 4 weeks post-operatively 2
  • Options include low molecular weight heparin or direct oral anticoagulants 2
  • Use in conjunction with compression stockings or intermittent compression devices 1

Wound Care Instructions

• Keep surgical site clean and dry
• Follow specific dressing change schedule as prescribed by surgeon
• For patients who had negative pressure wound therapy (NPWT), provide specific instructions for follow-up appointments 4
• Monitor for signs of infection: increasing pain, redness, swelling, drainage, fever 4
• Elevate the affected foot when sitting or lying down to reduce swelling

Weight-Bearing Instructions

• Weight-bearing status should be clearly specified based on:
  • Type and location of fracture
  • Stability of fixation
  • Soft tissue healing 5
• Most patients should use assistive devices (crutches, walker) initially
• Typically, patients will progress from non-weight-bearing to partial weight-bearing to weight-bearing as tolerated based on fracture healing 2, 5
• For metatarsal fractures: protected weight-bearing in a boot or hard-soled shoe for 3-6 weeks 5
• For more complex fractures: weight-bearing restrictions may last 6-12 weeks 6

Follow-up Appointments

• Orthopedic follow-up: 1-2 weeks after discharge for wound check and suture removal
• Subsequent orthopedic visits: 4-6 weeks, 3 months, and 6 months post-surgery for radiographic evaluation of healing
• Physical therapy evaluation: within 1-2 weeks of discharge or as directed by surgeon

Outpatient Physical Therapy Instructions

Phase 1 (Weeks 1-2)

• Goals:

  • Pain and edema control
  • Wound healing
  • Maintenance of uninvolved joint mobility

• Interventions:

  • Gentle ankle range of motion exercises (if permitted)
  • Toe flexion/extension exercises
  • Edema management with elevation and compression
  • Gentle massage of surrounding tissues
  • Upper body and core strengthening

Phase 2 (Weeks 3-6)

• Goals:

  • Improved range of motion
  • Progressive weight-bearing (as permitted)
  • Beginning proprioception training

• Interventions:

  • Progressive ankle and foot range of motion
  • Gentle strengthening exercises with resistance bands
  • Partial weight-bearing exercises (if allowed)
  • Proprioception exercises (seated)
  • Gait training with appropriate assistive device

Phase 3 (Weeks 7-12)

• Goals:

  • Full weight-bearing (if permitted)
  • Normalized gait pattern
  • Increased strength and proprioception

• Interventions:

  • Progressive strengthening exercises
  • Balance and proprioception training
  • Gait training without assistive devices
  • Functional exercises specific to patient's goals
  • Return to activity-specific training

Warning Signs to Report

Instruct patients to seek immediate medical attention if they experience:

• Severe, increasing, or uncontrolled pain
• Signs of infection (redness, warmth, drainage, fever)
• Numbness or tingling in toes
• Excessive swelling that doesn't improve with elevation
• Cast or splint problems (breakage, tightness, skin irritation)
• Chest pain or shortness of breath (possible pulmonary embolism)

Rehabilitation Considerations

The rehabilitation process constitutes the majority of a patient's recovery after compound foot fracture surgery and continues for some time after discharge 1. This process should be coordinated by the orthopedic team and physical therapists, aiming to return the patient to pre-fracture levels of activity 1.

Physical therapy frequency should typically be 2-3 times weekly initially, decreasing as the patient progresses and becomes more independent with their home exercise program.

Common Pitfalls and How to Avoid Them

1. Premature weight-bearing: Clearly communicate weight-bearing restrictions and consequences of non-compliance
2. Inadequate pain control: Regular acetaminophen should be sufficient; if not, prompt follow-up is needed 3
3. Wound complications: Provide clear wound care instructions and early follow-up for high-risk wounds
4. Venous thromboembolism: Ensure compliance with thromboprophylaxis and early mobilization 1, 2
5. Stiffness and muscle atrophy: Begin appropriate range of motion exercises early in recovery

By following these structured discharge and outpatient physical therapy instructions, patients with compound foot fractures can optimize their recovery and minimize complications.