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Are you awake during foot surgery?

Whether you will be awake or asleep during foot surgery depends on the type of procedure being performed. Many foot surgeries can be done under local or regional anesthesia, meaning you are awake but your foot is numb. However, some more complex or lengthy foot surgeries require you to be put under general anesthesia so you are fully asleep.

Quick Answers

Here are quick answers to some common questions about being awake during foot surgery:

  • Most routine foot surgeries like bunionectomy or hammertoe surgery can be done with local or regional anesthesia so you are awake but your foot is numb.
  • Surgeries like reconstructive foot surgery or surgery to fuse multiple bones often require general anesthesia where you are fully asleep.
  • Being awake under local or regional anesthesia can be better for quick recovery, but being asleep under general anesthesia is sometimes necessary for more complex procedures.
  • Your surgeon will determine the best anesthesia option based on the type of surgery, your health history, and your preferences.
  • Even if you are awake for the surgery, you will likely be given sedation medication through an IV to help you relax.

When You Can Be Awake for Foot Surgery

Many common foot procedures can be performed with the patient awake under local or regional anesthesia. Here are some examples:

  • Bunion surgery (bunionectomy) – This surgery to remove a bunion bone deformity is routinely done under local anesthesia or a regional nerve block.
  • Hammertoe surgery – Surgery to correct a hammertoe deformity is most often done under local anesthesia.
  • Neuroma removal – Removing an interdigital neuroma, a benign nerve growth between toes, is typically done under local anesthesia.
  • Ankle arthroscopy – This minimally invasive surgery to clean out or repair ankle joint tissues can be done under local anesthesia.
  • Bone spur removal – Removing painful foot bone spurs is most often done with local anesthesia.
  • Ingrown toenail surgery – Permanent removal or correction of an ingrown toenail can be performed with local anesthesia.
  • Plantar fasciotomy – This surgery to release tight plantar fascia tissue in the foot is typically done under local anesthesia.

These procedures are relatively routine and do not require significant manipulation of bones or tendons that would necessitate being asleep. The local or regional anesthetic numbs the foot so you do not feel pain, even though you are awake during the procedure.

When General Anesthesia is Needed

For more extensive foot and ankle surgeries, being fully asleep under general anesthesia is usually required. Reasons you may need general anesthesia include:

  • The surgery is complex or takes several hours to perform.
  • Bones or tendons need significant reconstruction or manipulation.
  • Grafts are required to repair injured tissues.
  • There are concerns about pain control with local anesthesia.
  • The procedure involves both feet/ankles.
  • You need to stay very still during the procedure.

Types of foot surgery that typically require general anesthesia:

  • Triple arthrodesis – Fusing multiple joints in the foot.
  • Tendon transfer – Moving a tendon to restore function.
  • Midfoot reconstruction – Repairing severely injured midfoot bones and joints.
  • Total ankle replacement – Replacing the ankle joint with an artificial implant.
  • Limb lengthening – Gradually lengthening foot bones using an external frame.
  • Excision of bone tumors – Removing benign or malignant bone tumors.

Since these surgeries are more involved, putting you completely to sleep allows for better pain management and the ability to manipulate the bones and tissues more extensively. It also keeps you still so the surgeon can perform fine tissue repairs.

Awake Anesthesia Options

When foot surgery is done with the patient awake, there are two main types of anesthesia used:

Local Anesthesia

  • Numbs a small, specific area of the foot.
  • Given by injections directly around the nerves and tissues at the surgical site.
  • Typically used for quick, minor procedures like bunionectomies or hammertoe surgery.
  • You are awake and aware during the procedure.
  • Wears off relatively quickly after surgery.

Regional Anesthesia

  • Numbs a large region of the foot by blocking nerves.
  • Done by injecting anesthetic near major nerves or using a nerve block catheter.
  • Provides numbness during lengthier surgeries like reconstructive surgery or triple arthrodesis.
  • You have no feeling or sensation in the numb region.
  • Takes several hours to wear off after the procedure.

Both local and regional anesthesia allow you to be awake for foot surgery while ensuring you don’t feel any pain during the procedure. Your surgeon will select the appropriate type based on the surgery being performed.

What to Expect Being Awake

If your foot surgery will be done under local or regional anesthetic, here is what to expect from the experience:

  • You won’t feel any pain, but may feel pressure or tugging during the procedure.
  • You will be given medication through an IV to help you relax before and during surgery.
  • A screen blocks your view of the surgery on your foot.
  • The anesthesiologist monitors you closely throughout the procedure.
  • You can listen to music or an audiobook during surgery to stay relaxed.
  • You may be able to get up soon after surgery since regional anesthesia wears off quickly.
  • You may be able to go home the same day as the surgery.

Even though you are awake, there are many techniques used to keep you calm, comfortable, and pain-free throughout the procedure. Talk to your surgeon so you know what to anticipate.

Recovery After Anesthesia

Recovery time after surgery depends somewhat on the type of anesthesia used:

Anesthesia Type Recovery Process
Local anesthesia
  • Numbness wears off relatively quickly, within a few hours
  • Can have nausea, dizziness temporarily after surgery
  • Usually able to go home same day
  • Fewer drug effects since anesthetic wears off fast
Regional anesthesia
  • Numbness wears off more slowly, up to 24 hours
  • Takes a few hours before you can walk comfortably
  • May require a longer stay in the recovery room
  • Low risk of nausea compared to general anesthesia
General anesthesia
  • Unconsciousness wears off gradually after surgery
  • Nausea, dizziness more common after waking up
  • Must stay overnight in hospital or recovery center
  • May take a few days to feel back to normal
  • No pain during recovery due to pain medication

In general, recovering after local or regional anesthesia is faster with fewer side effects. But your doctor will factor in many considerations when deciding which type is best for your particular surgery.

The Bottom Line

While some foot surgery can be performed under local or regional anesthesia, more involved procedures often require general anesthesia. The biggest factor in deciding to have you awake is how complex and lengthy the surgery will be. Simple bunion or hammertoe surgery can be done while you’re awake.

But triple arthrodesis, reconstructive surgery, total ankle replacement, and other complex foot surgeries typically require the deeper sedation of general anesthesia. Being asleep allows for detailed tissue and bone repair that would be difficult if you were awake.

Talk to your orthopedic foot surgeon about whether it makes sense to do your upcoming procedure with local/regional or general anesthesia. While being awake has some advantages, for many complex foot surgeries, the best option is general anesthesia so you are fully asleep and comfortable throughout.