Foot and Ankle Reconstruction with External Fixation

Who are your Surgeons?   

Dr. Rader has been trained nationally and internationally on the use of Ilizarov type external fixators for fixing complex foot and ankle deformities.  The device was originally invented in Siberia, Russia by Dr. Gavril Ilizarov and became the most sought after technique for major reconstructive surgery worldwide. Dr. Rader travels regularly to further their skills in this technique at seminars, conferences and fellowships. Our objective at Indiana Foot & Ankle is to provide you with world class care right here in the Ohio River Valley.reconstructive foot surgery

What is an external fixator?

External fixation is a method of holding bones and joints in proper position without screws and plates that would otherwise remain in your foot indefinitely.  A benefit of this technique is early weight bearing on the surgical foot and faster bone healing.  The fixator is a series of metal rings and wires or pins that pass thru the bone to hold the surgical positioning of the bones. The fixator weighs approximately 4 pounds. The fixator will remain in place for 8-12 weeks on average.  You will then return to the operating room to have it removed. The removal procedure will be minimal operating time under light anesthesia.

Day of surgery:

Your surgery is outpatient. Do not eat or drink for 8 hours prior to your surgery and take your usual medicines with a sip of water in the morning. You can expect the initial surgery to last several hours to apply the device. However, some take longer than others and this is not necessarily a sign of complication.  Our plan is you will go home the same day however, depending on your medical history and overall level of physical conditioning, the doctor might advise you to be admitted overnight for observation. If home health or any devices such as a wheelchair, walker or crutches are needed please let your surgeon know so they may be ordered prior to surgery. You will also go home with a prescription for pain medication. If you are taking pain medication prescribed from another doctor, it is your responsibility to notify your surgeon so that you are not at risk for over medicating. The rings on the outside of the foot & ankle are 6-8” in diameter wide therefore shorts or loose fitting clothes will be required to dress once the external fixator is applied.

What care do I provide?

Appropriate pin care is important.  The skin heals around each of the pins much like skin heals around an earring piercing.  The pin care during the first week is left up to the doctor and you will not have to do anything to the dressings.  You may wash yourself immediately after surgery provided that you cover the external fixator to protect the incisions from getting wet. After the second week, you may resume showering but no submerging the foot in water.  The dressings need to be removed in layers down to the skin. If the dressing material is difficult to remove you may use saline to moisten it for easier removal. There will be little rubber stoppers on the pins. Slide those away from the skin when cleaning. You will gently clean around the pin sites cleaning off any residue that has formed with rubbing alcohol. Once pin sites and area have been cleaned wash your hands thoroughly then slide the rubber stoppers back to the skin and apply new dressings.

Do not reuse soiled dressings.

What should I look for?

  • Loose nuts or bolts
  • Redness with thick drainage, odor or severe pain however, it is not uncommon to develop light redness and clear drainage around the pin sites.
  • Temperature over 101 Fahrenheit

If you see any of these, then call the office at 812-634-2778 for further instruction during office hours. After hours please call MHHCC at 812-996-2345 and ask for the surgeon on call for the practice to be paged.


Other Information:

The first week after surgery, it is critical that you keep the operated foot elevated. This will help relieving any post-surgical swelling and help immensely reduce pain.  Ice is to be applied behind the knee for no longer than 20 minutes every hour at a time, but never directly on the foot.

For the first two weeks after surgery, you are only permitted to weight bear on the operated foot for transfers only (sitting, standing, laying and when using the bathroom). You may find a family member helpful during this initial transition post-surgical for assistance. Your surgeon will notify you when full weight bearing is permitted.

Driving is strictly prohibited if the external fixator is applied to the right foot however, if applied to the left foot the doctor will advise when you may safely return to driving.

It is your responsibility to arrange for time off work however, your surgeon will complete FMLA paperwork upon request compliant with practice policy. Unless you have a job that allows you to sit down, please expect to be off work the remainder of your healing time.

Should you need a refill on your prescription Do Not Wait until you are out of medication and please allow 24 hours for the surgeon to arrange this with your pharmacy. Please plan for your follow up visits to last approximately 30 minutes. This will allow you to have all your questions answered and any issues addressed. It is a good idea to write down questions when you think of them so not to forget on the day of your visit.