Preparing for ankle surgery starts weeks before your actual procedure date. The work you do ahead of time, from strengthening your upper body to setting up your home, directly affects how smooth your surgery day goes and how quickly you recover. Here’s a practical timeline of everything you need to handle before you head to the hospital.
Get Through Medical Clearance
Your surgeon will require medical clearance before scheduling the procedure. This typically involves a visit with your primary care provider and a series of tests to confirm you’re safe for anesthesia. Expect a complete blood count to check for anemia or signs of infection, blood clotting studies to ensure you won’t bleed excessively, kidney function tests, electrolyte levels, and a blood glucose check. If you’re over 50 or have a history of heart problems, you’ll likely need an electrocardiogram as well.
Schedule this clearance appointment at least two to three weeks before surgery so there’s time to address any issues that come up. If your bloodwork reveals something unexpected, like poorly controlled blood sugar or a clotting problem, your surgeon needs time to adjust the plan rather than cancel the day of.
Manage Your Medications Early
Several common medications and supplements increase bleeding risk and need to be stopped well before surgery. Your surgeon’s office will give you a specific timeline, but the medications that typically need to be paused include:
- Pain relievers and anti-inflammatories: Aspirin (including Bayer, Ecotrin, and BC Powder), ibuprofen (Advil, Motrin), naproxen (Aleve), and diclofenac (Voltaren)
- Blood thinners: Warfarin (Coumadin), heparin, and injectable anticoagulants
- Herbal supplements: Ginkgo biloba, ginseng, and St. John’s Wort all interfere with clotting or interact with anesthesia
Bring a complete list of everything you take, including vitamins and supplements, to your pre-surgical appointment. Some medications need to be tapered rather than stopped abruptly, so don’t make changes on your own without your surgeon’s guidance.
Quit Smoking as Soon as Possible
If you smoke, this is the single most impactful thing you can do to improve your outcome. Smokers are 2.3 times more likely to experience non-union, where the bone simply fails to heal, compared to non-smokers. Smoking also raises your risk of post-operative infection significantly. The longer you can quit before surgery, the better. Even a few weeks of cessation improves blood flow and oxygen delivery to the surgical site, giving your bones and soft tissue a better shot at healing on schedule.
Start Prehabilitation Exercises
You’re going to spend weeks after surgery keeping weight off your ankle, which means your arms, core, and unaffected leg will be doing a lot of extra work. Prehabilitation, or “prehab,” builds the strength you’ll need to move around safely on crutches, a walker, or a knee scooter.
Focus on three areas. First, your upper body: seated push-ups (pressing up from the arms of a chair) strengthen the triceps, chest, and shoulder muscles you’ll rely on for crutches or a walker. Aim for about 10 repetitions twice a day. Second, your core and hips: gluteal squeezes and bridging exercises (lying on your back with knees bent and lifting your hips) build trunk stability, which protects you from falls when you’re balancing on one leg. Third, your unaffected leg: the knee and hip on your good side will absorb extra load for weeks, so strengthening your quadriceps and glutes on that side helps prevent overuse pain.
Starting these exercises two to four weeks before surgery gives you meaningful gains. Even if your ankle is currently painful and limiting your mobility, most prehab exercises can be done seated or lying down.
Choose Your Mobility Aid
You’ll be non-weight-bearing after ankle surgery, so you need a plan for getting around. The two most common options are standard crutches and rolling knee scooters.
Research comparing the two found that patients were significantly more satisfied with knee scooters and used them more frequently throughout the day. Patients on crutches reported 22 total falls compared to 14 falls in the knee scooter group, and when asked which device they’d choose for a future surgery, patients overwhelmingly preferred the scooter. Knee scooters work well on flat surfaces and require less upper body effort, but they’re harder to use on stairs and uneven ground. Crutches are more versatile for navigating steps and tight spaces but demand more arm and shoulder strength.
Factors like your body weight, home layout, and procedure type (forefoot versus hindfoot) didn’t significantly affect fall risk with either device. Age was the only factor with a slight association to more falls, regardless of which aid was used. If you’re older or have balance concerns, practice with your chosen device before surgery day so it feels natural.
Set Up Your Home for Recovery
You won’t want to be rearranging furniture while hopping on one leg. Do this work in advance.
Start by creating a recovery station on the ground floor if your home has stairs. You’ll need a comfortable place to sit or recline with your leg elevated, plus easy access to a bathroom, your phone charger, medications, water, and snacks. Keeping your foot elevated above heart level when sitting or lying down is one of the most effective ways to control swelling and reduce pain in the first weeks.
Remove scatter rugs, doormats, and any loose cords from the paths you’ll travel on crutches or a scooter. These are fall hazards even when you have two good legs. Check whether you can get in and out of your bathtub or shower easily. A shower chair and a handheld showerhead make bathing dramatically easier when you can’t stand on both feet. You’ll also need a waterproof cast cover or heavy-duty plastic bag to keep your surgical dressing dry once you’re cleared to shower.
Stock your kitchen with easy meals and put frequently used items at counter height so you’re not reaching overhead or bending down while balancing. Fill prescriptions ahead of time if your surgeon has already written them.
Arrange Help for the First Two Weeks
Plan on needing someone with you for at least the first one to two weeks after surgery. During this stretch, you’ll likely need help with bathing, using the bathroom, cooking, running errands, shopping, and getting to follow-up appointments. The first 48 hours are the most dependent period, when anesthesia is still clearing your system and pain is at its peak.
If you don’t have a friend or family member who can stay with you, ask your surgeon’s office about home health aides or visiting nurses. Arranging this before surgery is far easier than scrambling afterward.
Gather Your Recovery Supplies
A few items will make the early days of recovery significantly more comfortable:
- Elevation pillows or a wedge: Keeping your ankle above heart level reduces swelling and pain. Regular bed pillows work, but a foam wedge holds position better while you sleep.
- Ice packs or a cold therapy system: Icing the surgical area is a frontline tool for managing swelling and discomfort.
- Waterproof cast cover: Essential once you’re cleared to shower.
- Shower chair and grab bar: Standing in a wet tub on one foot is a recipe for a fall.
- Loose, comfortable clothing: Pants with wide legs or zip-off bottoms that fit over a cast or boot.
- A bag or backpack: When you’re on crutches, you have no free hands. A small backpack lets you carry your phone, water, and medications between rooms.
Follow Fasting Instructions Precisely
If your surgery involves general anesthesia or sedation, you’ll need an empty stomach to prevent the dangerous possibility of inhaling stomach contents while you’re under. The standard rule is to stop eating solid food six hours before your anesthesia start time, or eight hours if your last meal was heavy or fatty. Clear liquids like water, black coffee, tea, or juice without pulp are typically allowed until two hours before surgery, and current guidelines actually encourage drinking clear fluids up to that two-hour mark to avoid dehydration.
Milk, cream in coffee, smoothies, and protein shakes count as solids, not clear liquids. If you’re unsure about a specific drink, treat it as a solid and stop it at the six-hour mark.
Prep Your Skin the Day Before
Surgical site infections are a real concern with any orthopedic procedure. Many surgeons ask you to wash the ankle and lower leg area with an antiseptic soap containing chlorhexidine gluconate (often sold as Hibiclens) the evening before surgery and again the morning of. This reduces the bacterial load on your skin at the incision site. Follow your surgeon’s specific instructions on how many times to apply it and whether to let it air dry. Don’t shave the surgical area yourself, as small nicks in the skin create entry points for bacteria.
What to Bring on Surgery Day
Keep it minimal. Bring your ID, insurance card, and a list of your current medications and allergies. Wear loose, comfortable clothing and leave jewelry, watches, and valuables at home. You’ll change into a hospital gown, and your personal items will be stored during the procedure. Bring your crutches or have your knee scooter in the car so they’re ready when you’re discharged. Most ankle surgeries are outpatient, meaning you’ll go home the same day, so have your ride arranged in advance. You won’t be allowed to drive yourself.