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The response to the question below was authored by Marc Mitnick DPM

Cold foot 3 weeks after surgery

by Tina
(Torrance )

Hi,

My husband had surgery 3 weeks ago on his ankle to remove two lesions from previous injury. He also has an incision on the lateral portion of his foot from where they thought they'd do a tendon and ligament repair but after getting inside they felt it wasn't necessary. Surgery went great, splint came off after 2 weeks and he now is none weight bearing with a boot, allowed to flex/extend the foot which he does many times a day. Capillary refill is great, bruising is going down and incisions look great. Only problem is, his foot remains cold as ice even with thick socks on. Skin is maybe on the pale side, but not noticing much difference from the other foot I don't think. Should we be concerned? If he has decreased circulation due to lack of movement with the foot, could this greatly effect healing? Thanks!

RESPONSE

Hi Tina,

Two possible conditions come to mind after reading your narrative. Keep in mind I am not making a diagnosis as that is impossible from the other side of the internet.
The first possibility is Complex Regional Pain Syndrome or CRPS. This happens in individuals who have had foot surgery and generally end up in a boot or cast. It is essentially a short circuiting of the nerve transmission from the foot to the brain and the brain to the foot.
You can read about it on my site.
It can be difficult to diagnose and the further along it goes, the more difficult it is to treat.
If not diagnosed and treated, it can have debilitating effects.
The second possibility is that of an arterial embolism or a blood clot in one of the arteries that goes down the leg. I know nothing about your husband's medical history or even his age for that matter, so I have no idea it he is at greater risk for this problem. If an artery is being blocked then obviously everything below the blockage will be colder and paler.
When one foot is noticeably colder and paler then the other foot, that is a sign of diminished circulation coming into the colder foot; that is not good and needs to be addressed immediately, regardless of the source.
I would call his surgeon immediately and if for some reason you cannot get in touch with he or she, then I would suggest you take him to your local Emergency Room and have the foot checked out.

Marc Mitnick DPM
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Dec 26, 2016
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Reply
by: Tina

Thanks for your input, I've put a call out to the surgeon on call. He says it is not as cold all the time, but really will only be warm when wearing socks and under the covers. If he takes off his sock and boot, however, it will become ice cold whereas the other foot is just fine. I'm hoping that the fact it CAN get warm and is not constantly cold is a good sign? My husband feels like his for us just cold because he's not using it but that doesn't make sense to me. Is ANY difference in foot temperature between the two feet considered normal after surgery?
------------------------------------------------------------
The problem with discussing foot conditions without actually being able to see the foot creates an obvious difficulty for me. I would rather err on the side of caution then tell you not to worry about the cold foot.
Let your surgeon decide whether or not there is an issue. Also direct your questions to the surgeon because ultimately he or she is responsible for the post op care of your husband's foot. I think that is the best advice I can give you.

Marc Mitnick DPM

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Illinois Bone and Joint Institute

Mount Sinai Hospital

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University of Florida Health

American Family Physician

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Cold foot 3 weeks after surgery

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