The Center for Podiatric Care and Sports Medicine

NYC Podiatrists Discuss: Foot Pain After Surgery and Avoiding Opioid Dependence

Posted by on Friday, December 7th, 2018

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According to the CDC, an average of 115 Americans die of an opioid overdose every day. The misuse of prescription painkillers is one of the greatest crises our nation faces. By some estimates, nearly a third of the people prescribed opioids take their pills improperly. According to the National Institute on Drug Abuse, 8-12% of opioid users become dependent on the drugs, and 4-6% transition to heroin. In addition to the 33,000 Americans who die from overdose, another 2 million people suffer from substance use disorders.

Naturally, as healthcare providers with the power to prescribe such potent painkillers, we take our role in all of this very seriously. After all, orthopedic surgeons are the third-largest prescribers of opioids. Whenever possible, we explore effective alternatives when helping patients deal with foot pain after surgery. We keep a close eye on the latest research to learn more about which patients are at highest risk of developing a psychological disorder or physical dependence on opioids.

foot pain after surgery
Whenever possible, we explore effective alternatives when helping patients deal with foot pain after surgery. [Image Source: Pexels user Pietro Jeng]

Who Is at Risk for Opioid Dependence?

Dr. Fred Finney and his medical team at the University of Michigan found the rate of new, persistent opioid use to be 6.2% for bunion surgery patients and 8.8% for open ankle surgery patients. Researches found the following factors played a role in opioid dependency:

  • Timing. Those who refilled their preoperative prescription 30 days before surgery were more likely to continue using three months after surgery.
  • Dosing. The strongest predictive factor in addiction was the fact that patients were initially given high doses.
  • Mental health. If you have a past history of regression, depression, alcohol abuse, substance abuse, anxiety, depression, and pain disorders, you will be more likely to abuse opioids.

Researchers found that factors like age, gender, and income did not matter.

Opioid Abuse and Surgical Complications

While the 7% of bunion surgery patients who continue using opioids long-term doesn’t seem like such a huge percentage, the new-use rate is significantly higher than the 5% common to other noncancer patients. Given the low complication rate associated with podiatric surgeries, the risk of opioid dependence is actually one of the most common complications associated with hallux valgus correction or open ankle surgery.

Alternatives for Foot Pain After Surgery

Data shows the average patient takes about 30% of what the physician prescribes, 80% takes less than 50% of what is prescribed, and 22% take none of the opioids at all. We make sure every patient leaves our office with a thorough idea of what to expect after surgery, how to take the medication prescribed, and what else can be done to manage discomfort. The initial recovery period from a procedure like bunion surgery is six weeks but effects can be felt up to six to 12 months afterward.

“Opioids can be helpful for some patients,” explains Dr. Josef J. Geldwert, DPM. “However, a good and responsible practice doesn’t simply write out a huge script for the longest duration and highest dosage with the end goal of ‘patient satisfaction.’ At our practice, we work with individuals, tailoring our pain management strategy based on patient health histories. With quality multimodal care, opioids can be part of a comprehensive plan or they may not be necessary at all. There are anti-inflammatory drugs, anti-convulsants, and topical analgesics that can be just as effective after surgery. If the pain is enduring or increasing after you go home, we always want to see you again right away, rather than leave you to go it alone and attempt to self-medicate.”

NYC Podiatrists Can Help

At our Manhattan and White Plains offices, we offer advanced-level care and pain management. We use long-lasting localized anesthetics that get you through the first few days after surgery more effectively. We’ll train you how to use ice, elevation, compression, massage therapy, and NSAIDs to manage your pain on your own at home. Contact The Center for Podiatric Care and Sports Medicine to learn about ways to deal with pain after surgery.

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If you have any foot problems or pain, contact The Center for Podiatric Care and Sports MedicineDr. Josef J. GeldwertDr. Katherine Lai, Dr. Ryan Minara and Dr. Mariola Rivera have helped thousands of people get back on their feet. Unfortunately, we cannot give diagnoses or treatment advice online. Please make an appointment to see us if you live in the NY metropolitan area or seek out a podiatrist in your area.