What Does Smoking Have To Do With My Foot Surgery?!?!

Imagine being on crutches for 4 weeks following foot and ankle surgery. Imagine the inconvenience and the potential loss of income due to having surgery. Now imagine, you are not healing and not progressing the way you should. Let us run through a common scenario with my preoperative patients. We discuss their proposed surgery. We discuss their recovery and every aspect of the surgery. We then turn to their health history. We ask what medications they are taking. We ask what health problems they may have. And then we ask that dreaded question…….. "Do you smoke or use tobacco?" In many instances, the response is, “What does that have to do with my surgery?” Well, it has a lot to do with your surgery and recovery.

Tobacco is one of the #1 risk factors for complications for foot and ankle surgery. There are numerous reasons for this. Cigarette smoking has been shown to be the most important variable risk factor causing peripheral arterial disease. Nicotine exposure can cause increased vessel density and vasoconstriction (tight blood vessels) which can lead to decreased blood flow to the affected area. This means decreased healing potential and increased possibility of complications.

Cigarette smoking is also implicated in poor wound and bone healing. It has been shown that smoking 1 cigarette can cause 90 minutes of decreased oxygen to the extremities which means that the wounds that need to heal are not the getting the oxygen and blood flow that is required. This means that if you are smoking a pack a day, your body is working on a full day of lack of oxygen to the tissues that need to heal.

Studies have shown that patients having foot surgery who smoke, versus do not smoke, versus are exposed to secondhand smoke will heal almost 50% slower when they smoke and 25% slower if they are exposed to secondhand smoke.

Current recommendations are to not do elective foot surgery on patients who are currently and actively smoking. Therefore, if you are considering surgery, you should definitely consider quitting smoking. Otherwise, you will be advised to quit smoking 3 weeks prior to your surgery, and you will be advised that we will do blood testing prior to your surgery with a test known as nicotine and cotinine to ensure that you no longer have nicotine in your system.

Please remember, this is not a punitive or a judgment decision, our job as healthcare providers is to ensure that you have the best possible outcome. We will make every effort to assist you in your smoking cessation and advise you to discuss smoking cessation with your primary care physician or go online at Smokefree.gov.