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The main goal of home preparation is to minimize your need to move around and to increase your access to those essentials you need for successful recovery.
What is the best way to prepare your home for recovery after surgery?
- Transform your home into recovery space
- Gather offloading modalities such as crutches, walker, knee roller
- Practice using offloading equipment
- Create accommodations and make preparations for your pets
Here is a list of easy to implement ideas to consider
Try to arrange your home into a recovery space to allow for ease of travel/short distance between your bed/rest area and bathroom. If this is not feasible because of your home arrangement, discuss obtaining a portable commode with your surgery team prior to undergoing your procedure. Urinals may be available as well. These items are frequently covered by insurance and can be extremely helpful in preventing falls associated with travel around the home.
Have your recovery area/sleeping area on the first floor of your home, if you live in multiple story building. Again, this is to minimize travel and allow you to leave your home with minimal effort. Having to climb stairs in a situation when you have to be non-weight bearing on surgical foot is a major risk factor for falls and sprains. If you absolutely must climb stairs, I recommend that you work closely with physical therapist before you undergo surgery to build up your upper body strength, stability of contra-lateral extremity, balance and proprioception.
Make sure you have enough food, personal hygiene items and have addressed any business and home related issues to cover you for at least a 2-week period. It is during this time that you will have the most pain, discomfort, anxiety, and frustration associated with surgical rehabilitation. This is expected and you will have skills to deal with those. However, this is exactly why you do not want to be overwhelmed with issues outside of your healing process and rehabilitation during this critical time. Of course, your recovery is likely to take longer than that but that is why you will have good social support structure to rely on during and beyond the 2-week period.
Having a comfortable bed or recliner that allows for placement of foam wedges or multiple stacked pillows for leg/ankle/foot elevation is essential to reduce swelling and associated pain. If you do not have a bed like that, you should discuss obtaining a hospital bed with your surgery team. Again, these are frequently covered by your insurance provider but must be requested ahead of time to allow for timely delivery and set up.
Ensure that the items you need to use on regular bases such as cups, plates and silverware, phone charger, computer, and food are at your shoulder to waist level to avoid reaching, kneeling and squatting.
Keep night lights on in rooms/areas where you frequently travel. Remove easily movable small rugs and runners to avoid slipping and falling.
If you have pets
Research a respectable pet sitter/walker or long-term pet placement prior to your surgery. You want the best for you and your pet and want to ensure that they are well cared for as you are recovering. Do not under estimate how challenging it may become to care for your pet when you are on crutches and have to balance on one foot.
Equipment
Consider getting a walker, especially if recommended by your physical therapist, prior to your surgery and practice using it. Many younger patients find use of the walker embarrassing for some reason. Think of it as a temporary medical device that is helping you heal and is protecting you from falls ensuring proper recovery and return to normal activity. Keep things in perspective. Walker with a basket could be particularly helpful to move things around the house if you need to travel from room to room. Keep your hands occupied with the offloading protective device. If you cannot get a basket on a walker, fanny pack may service a similar purpose.
Depending on your expected activity level, you may need to obtain items with long handles to assist you with reaching. This may include long handles for shower sponge and shoe horn. Sock aid frequently used to help with putting on compression socks may be helpful. You may want to consider installing grab bars in the shower, bathroom area and hallways to assist with transfers. It is important to install them vertically or horizontally to allow for easy of handling and prevent hand slipping. Towel racks are not a substitute for a grab bar as they are not designed to withstand the pull power required to get up from a seated position or grasp power needed to achieve stability. If you are not skilled to install these items, call a trusted handyman. This person may also assist you with installation of a hand held shower which will certainly help with washing in a seated position.
Investing in a quality reacher device will help to avoid stopping and kneeling to get items from the floor and nearby surfaces. Placing a non-skid mat in the bathtub should help prevent slips and falls and should help with balance. A shower chair is another item frequently covered by insurance that should be strongly considered. Having a raised toilet seat will make getting up from a seated position much easier as well.
Proper offloading of surgical limb requires being fit for proper offloading modality that works for your weight, height, offloading need, and living arrangements. It is challenging to customize a device like that on your own. That is why I strongly recommend pre surgical physical therapy assessment.
Get some help
If you are unable to secure a friend or a family member to help you during recovery, discuss this with your surgery team. Many insurance plans cover the service of a wound care nurse, at home physical and occupational therapist as well as home health aid on temporary bases. These individuals may fill in the gaps in the care you will need when the friends and family are unavailable.
Alert your local post office to hold your mail or ask a trusted person to check your mail to avoid trips to the mail box. Convert your bill pay from paper to online/internet options to save on stamps and avoid trips to the post office. Enlist the help of a neighbor or a friend to help with rolling out and then bringing in of heavy garbage bins, if your living arrangement requires this task.
The most common offloading modality is crutches.
Crutches are one of the oldest offloading modalities. They come in different variations that were designed for specific injuries and illnesses. It is important to understand what a specific crutch design is meant to do to ensure you are using the right type for your specific situation.
1. Standard crutches
2. Canadian crutches
3. Forearm crutches
4. Knee crutches
How to fit your crutches:
Stand straight and balanced with both feet firmly planted on the ground. Make sure to purchase and wear a firm, supportive, slip proof shoe for the side that will be bearing your weight when using crutches.
Put the crutches under your arms. Ensure two-inch space or at least 2 finger widths between your armpit and the top of the crutch handle. Do not lean forward or stoop.
Elbows should be bent to about thirty degrees. Crutch hand grips should be at the level wrist level.
How to stand up Hold both crutches by the hand grips with hand and push up with the other hand off and away from a firm stable surface. After that, properly position each crutch under each arm.
How to Sit Down Keep both crutches in one hand holding them by the hand grips, then reach for a firm stable surface with your other hand to lower yourself slowly into a seated position.
How to walk
To make a step, keep the crutches between upper arms and ribs. Place the weight through your hands and avoid pressure on armpits. Do not swing on crutches. Keeping pressure on armpits results in compression of nerves to the arms and will result in numbness and discomfort to arms and hands.
Move the crutches in front of you. Then move your surgical leg forward and place the foot of that leg in line with crutches. Place as much weight as you are allowed on the surgical foot. The rest of the weight should be carried by your arms/hands. Keep the weight completely off the surgical foot if indicated to do so by your surgeon.
Step past the crutches with the stronger leg.
Sequence of motion is crutches first, then injured leg followed by stronger leg.
Going Up and Down stairs
Here is a great Youtube video by internet famous physical therapy duo Bob and Brad explaining the logistics:
Using walkers for offloading: Two wheeled and Four-Point
Using a cane for offloading
Using Iwalk device for offloading
This innovative device allows you to free up your hands as you are taking the weight off your foot completely, which is a major advantage. The downside of this device is that it requires really good sense of balance to avoid falls. If you are leaning towards the use of this device, I strongly recommend trialing it out indoors and outside the home before you have surgery.
Knee rolling walker or knee scooter
Here is a nice summary of this device by Dr.Tom Beirnacki, including benefits and downsides. Again, stability is a major issue with this device. The fall risk is likely a bit less than with the Iwalk device but there have been plenty of cases where people fall forward and over the scooter, especially when navigating on uneven surfaces.
Using wheelchair for offloading
This one is the least favorite method of offloading for most people. The benefit of wheelchair is that it allows for some mobility and independence if you have strong upper extremities. Frequently, however, use of this device requires assistance of a person to push the wheelchair to allow for mobility. Sitting in the wheelchair leads to overall body conditioning and weakness, as well muscle atrophy, which then necessitates prolonged rehab. Discuss stretches and strengthening exercises while in the wheelchair with your physical therapist. Also, it is essential to practice safe transfers and to always remember to lock the wheels to avoid ending on the floor. If you have pre-existing difficulty with balance, wheelchair may be the optimal choice for you to allow for protection of surgery site and to keep you safe from falls. Some wheelchairs come equipped with Leg extension, which allows for elevation of the leg/ankle/foot when in the chair. Of course, elevation is very helpful for swelling reduction. It is unclear how much swelling reduction actually happens as your lower limb is below the level of the heart when sitting in a chair. In fact, if you had heel surgery, it will likely cause more fluid to collect around the heel and ankle area because gravity always brings fluid to its lowest point in the body.
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Author bio:
My name is Dr. Marat Kazak. I have been working as a professional Podiatrist serving Northern California community since 2014. My extensive medical and surgical knowledge combined with an ongoing curiosity to learn about the latest trends define my success in the field of foot, ankle and leg medical and surgical care.
The goal of this website is to give you the tools to better care for yourself, to dispel medical myths, and to empower you with information to save time and money! If you are looking for an answer on foot and ankle pain, this is the place to find it. If you do not see your topic of interest covered, please send me a message and I will do my best to discuss it thoroughly in my next upcoming post.
Visit this blog often to learn about latest developments, treatments, and approaches to healing and recovery!