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3 RULES: You will be asked “what are the three rules”?

  1. After surgery you will 1.“KEEP YOUR TOES ABOVE YOUR NOSE.” This means that you MUST have your feet elevated higher than your heart. Keeping your toes above your nose helps to heal the muscles and skin (soft tissues) by reducing swelling in your leg. This position also helps to prevent infection, and is very important in avoiding deep venous thrombosis (blood clots).
  2. In order to keep the blood circulating in your legs and in order to avoid deep vein thrombosis (blood clots), we ask patients to 2. “GET UP ONCE AN HOUR” during the day. This means you should at least go across the room and come back. You should not be up for long periods of time. In most cases we will not have people immediately put any weight on their operated foot/ankle. So the third rule is, 3. “DO NOT STEP ON YOUR FOOT”. This is important to prevent loosening of metal or other devices holding the bones and soft tissue together. It also prevents irritation of the soft tissues which can lead to prolonged healing. When we say get up once an hour, please walk, hop or move with an assisted device. This is important!
  3. Do not do any excessive walking during the first few days after surgery. Recovering from surgery is a full-time task for the patient. Immobilization of the operated upon extremity is important to avoid irritating the skin incision, which can lead to infection. Please do not plan activities or go out of town for several weeks after surgery. If you are unsure about your future activities, please schedule surgery only when you know it is acceptable for you. Scheduling surgery and then canceling the date, prevents other people from having surgery on that date as it takes time to line everything up effectively. If you cancel your surgery the week of your planned surgery, we reserve the right to cancel all future surgical procedures.

Pain & Pain Mediction

  • Prescription pain medication can and will depress your respiratory system if taken in excess. The goal of pain management with prescription pain medicine is to be comfortable not pain free. If you take enough narcotics to be pain free then you run the risk of stopping breathing. If this happens, call 911 immediately! Do not take this medicine if you are drowsy or slurring your speech.
  • Fill the pain medicine prescription during surgery. Start taking the pain medication when you first start to have pain or when you start to notice tingling as the numbing medicine wears off (if you had a local injection). Remember, ice applied to the affected area or the area above the bandage can often take the pain away more than medication. For ice application, cover the area with a towel. Put crushed ice in a plastic zip lock bag, and place over the affected area. Let the ice sit on your leg for about 12-15 minutes. You may do this four times per day. If you buy a commercial cold pack, you may use this for one hour on and two hours off.
  • Pain in the heel is often caused by pressure from the weight of your foot on the bed. Make sure your heel is suspended off the bed by keeping a pillow underneath your calf not your knee.
  • If you are having too much pain after surgery, it may be from swelling in your foot or ankle. It may be necessary to split the cast or dressing to get relief. Please call us if you think this may be the case. If it is an emergency, go to your local emergency room. As a last resort, you may cut the dressing on the side opposite the operated area.

After Your Surgery

  • Bleeding through the bandage almost always occurs. Do not let this alarm you. Simply add more gauze or a towel, call us, and come in for a dressing change the next day. If you think it is excessive, contact us immediately or go to the local emergency room.
  • Do not get the bandage or cast wet. Showering is possible with plastic protectors/ commercial cast bags. Be very careful, as the bathroom can be wet and slippery. If you do get your dressing wet, it should be changed immediately; please contact us.
  • If you were given a special shoe to use after surgery, you MAY NOT walk without it. You do not have to wear it in bed. You may be able to walk on the heel if you had surgery on your toes or ball of your foot. Please use your walker, crutches or other assistive device as instructed. Specialized kneeling scooters are available as well (e.g. Roll-A-Bout, Turning Caddy, etc).
  • Please ask Dr. Gross or his resident to explain any of the above if it is not clear to you. Remember, we are in this together and want very much for you to have positive results. Please call Dr. Gross’s office if you have any questions. After hours or weekend, PLEASE CALL (843) 792-2300 MUSC ask for the orthopedic resident on call.
  • Once you are out of your cast and/or removable boot, swelling may persist for 6-12 months. Wearing compression hose (elastic stockings) can help avoid some of this swelling. Be sure to ask Dr. Gross for a script to obtain these from your local orthopedic supply store. You might also experience a bluish discoloration of your leg. This is normal and part of the usual postoperative experience.

Diet & Comfort

  1. Return to your regular diet as tolerated. Begin with light or bland foods. Drink plenty of fluids.
  2. Take your pain medication as prescribed. Take pain medication with food to minimize nausea.
  3. If you have had a surgery for a fracture or joint fusion do NOT use NSAIDs such as Ibuprofen, Aleve, etc as this can inhibit bone healing. Do NOT take additional tylenol if your pain medication already has tylenol in it (ie-Norco, Percocet, etc)
  4. Do not drink alcohol or drive while using prescription pain medications

Cast Instructions

You may or may not get a cast following surgery. If you do, please pay close attention to the following.

  • After application of a splint or cast, it is very important to elevate your leg for 24 to 72 hours. The injured area should be elevated well above the heart. Remember “Toes above your Nose”. Also, rest and elevation greatly reduce pain and speed the healing process by minimizing early swelling.

Call Dr. Gross’s office, Call the places and numbers listed above or visit local emergency room if you have

  • Significant increased pain, which may be caused by swelling, and the feeling that the splint or cast is too tight
  • Numbness and tingling in your hand or foot, which may be caused by too much pressure on the nerves
  • Burning and stinging, which may be caused by too much pressure on the skin
  • Excessive swelling below the cast, which may mean the cast is slowing your blood circulation
  • Loss of active movement of toes, which requires an urgent evaluation
  • Loss of “capillary refill”. Pinch the tip of toes and blanch the skin. Release pressure and if the skin does not return pink then call office immediately.

DO NOT GET YOUR CAST WET. Bacteria thrive in moist dark areas. We do not want this. If your cast becomes wet, return to the office and we will apply another one.

Important Phone Numbers

Night and Weekend assistance: Call MUSC (843) 792-2300 and ask for the orthopedic resident on call. If it is an emergency, call 911!

Dr. Gross also wants you to know that he does work with orthopedics companies as a consultant, designer and teacher. A full disclosure is available from

  • American Academy of Orthopaedic Surgeons
  • Arthroscopy Association of North America
  • American Orthopaedic Association
  • South Carolina Orthopedic Association