Your Recovery Guide

Support your healing

• Stay well hydratedWater transports healing molecules to the treatment site.
• Tylenol / acetaminophen for painDoesn't interfere with the healing cascade.
• Vitamin C — 1,000 mg dailyA cofactor for collagen synthesis.
• Gentle daily stretching5–10 min of calf/Achilles stretching maintains mobility.
• Supportive shoes & orthoticsReduces mechanical load on the treated area.
• Reduce strenuous activity by 50%Protect the treatment zone while staying gently active.

Protect your results — avoid

• NSAIDsIbuprofen, Advil, Naproxen block the pathway EPAT/EMTT activate.
• Icing more than 5–10 min/daySuppresses the inflammatory signal needed for repair.
• Cortisone/steroid injectionsThese suppress the cellular healing response.
• Excessive high-impact activityStrains new collagen before it matures.
• Inflammatory foods & smokingImpair oxygenation and slow repair.

Your healing timeline

Recovery timeline

Safe pain relief

• Tylenol (acetaminophen)Preferred pain reliever — doesn't interfere with healing.
• Cold pack over clothing15 min, 3–4×/day. Not directly over the injection site.
• ElevationFoot above heart level when resting.
• Light compressionNot tight enough to restrict circulation.

Avoid

• NSAIDsAvoid at least 4 weeks — they suppress the response PRP depends on.
• Corticosteroid injectionsAvoid in the same area for at least 6 weeks.
• High-impact activityRunning, jumping, heavy lifting — avoid for 2 weeks.
• Smoking & alcoholAvoid at least 2 weeks — both impair the healing process.
• Heat & soakingNo hot baths, pools, hot tubs, or saunas for 72 hours.

What to expect

Support your recovery

• Rest 24–48 hoursLimit walking/standing while the steroid activates.
• Ice 15–20 min as neededWrap in a thin towel for soreness, first 48 hours.
• Keep bandage dry 24 hoursThen remove — normal showering is fine after.
• Tylenol / acetaminophenSafe — won't interfere with the steroid's effect.
• Diabetics — monitor blood sugarSteroids can temporarily raise blood sugar for 3–5 days.

Avoid

• NSAIDs for 48 hoursThey counteract the steroid — use Tylenol instead.
• Heat or massage for 48 hoursCan increase inflammation at the injection site.
• Soaking for 48 hoursNo baths, pools, or hot tubs.
• High-impact activity, 1–2 weeksStresses the area before the steroid does its work.

First 24 hours

• Keep the dressing intactLeave it on until the following morning. Loosen if tight — don't fully remove.
• ElevateFoot raised above heart level to minimize swelling.
• Walk on your heelOpen-toed shoes or a wide toe-box shoe reduce pressure.
• Pain managementTylenol or Ibuprofen as directed on the packaging is typically enough.

Soaking — starting 24 hours after

• SolutionLukewarm water to cover both feet + up to 2 tbsp Epsom salt + 3–4 squirts Hibiclens.
• Soak both feet, 10–15 min, twice dailyContinue for 7–14 days or as directed.
• Clean gentlyUse a clean Q-tip along the nail groove — don't dig or scrub.
• After soakingPat dry, air dry a few minutes, then rebandage.

Wound care

• Bacitracin ointmentThin layer on the surgical site after each soak.
• DressingClean Band-Aid or non-stick gauze; change daily or if wet/soiled.
• Some drainage is normalClear to light-pink watery drainage is expected the first several days.

Soaking instructions

• Solution½ gallon lukewarm water + 2–3 tbsp Epsom salt + 4 squirts Hibiclens. Stir gently.
• Soak 20 minutesOnce daily, 4–5 days per week.
• After soakingPat dry, air dry a few minutes before socks or shoes.

Treating your shoe environment

• SocksWash in warm/hot water — regular bleach for white, color-safe for colored.
• ShoesUse Clean Sweep antifungal spray inside shoes once a week — ask our staff.
• Moisture-wicking socksFungi thrive in warm, moist environments.

Stretch 1 — Wall Stretch, Knee Straight

• Set upPalms flat on the wall at chest height, shoulder-width apart.
• Step back ~2 feetKeep the back leg completely straight — knee must not bend.
• Heel flat, lean inPress the back heel into the floor; lean hips toward the wall until you feel a strong pull in the upper calf.
• Hold still — no bouncingBreathe slowly for the full 30 seconds.

Stretch 2 — Wall Stretch, Knee Bent

• Same position as Stretch 1Palms flat, back foot stepped behind you, leaning forward.
• Bend the back knee ~20°A small, controlled bend — the only difference from Stretch 1. Back heel stays flat.
• Sink hips slightlyIf your heel lifts off the floor, you've bent the knee too far — straighten slightly.
• Feel it lower, near the AchillesThis is the soleus — subtler than Stretch 1. Hold the full 30 seconds.

Complete sequence

• Stretch 1 (30 sec) → rest 10 sec → Stretch 2 (30 sec) → switch legs. Repeat 3× per session, 2–3× daily.

Important reminders

• Never bounceHold steady the entire time.
• Avoid NSAIDs during treatment
• Avoid bare feet on hard floorsWear supportive shoes.

Best done before your first morning steps and after prolonged sitting.

Wearing your boot

• Boot on before your foot touches the floorEvery time you stand or walk, unless we've specifically told you otherwise.
• Snug, even strap tensionStart at the ankle strap and work up — should feel firm, not painful or numbing.
• Wear the liner sockProtects your skin and manages moisture — change it if it becomes damp.
• Re-check straps each morningSwelling changes overnight — the boot that fit yesterday may need adjusting today.
• Walk with a natural heel-to-toe motionThe rocker sole is designed for this — don't shuffle flat-footed.

Sleeping & taking it off

• Follow your specific instructionsSome injuries allow removal for sleep; others require the boot 24/7. If you're unsure which applies to you, call us before assuming.
• Brief removal for hygiene is okay if approvedKeep weight completely off the foot while it's off, unless told otherwise.
• Elevate whenever the boot is offFoot above heart level helps control swelling between wears.

Avoid

• Walking without the bootEven a few steps to the bathroom count — undermines the healing you're protecting.
• Getting the liner or your skin soakedShower with the boot off only if approved for weight-bearing — otherwise use a waterproof cover and keep the foot dry and elevated outside the tub.
• Driving on the affected sideDo not drive with the boot on your gas/brake foot until we've cleared you.
• Loosening straps to fit a shoe over itDefeats the immobilization the boot is providing.
• Ignoring rubbing or a pressure spotAddress it early — it can progress to a skin breakdown if left alone.

Caring for the boot

• Wipe the liner with a damp clothAir dry fully before wearing again — do not machine wash or dry.
• Bring the boot to follow-up visitsWe may need to adjust the fit as swelling improves.

Break-in schedule

Placing them in your shoe correctly

• Arch (medial) side goes in firstAngle the orthotic in so the inner/arch edge seats into the shoe before the outer edge.
• Push it all the way backSlide the orthotic fully into the heel cup of the shoe. If it sits too far forward, the arch will press against a spot it isn't shaped for, causing extra pressure on the inside of your arch.
• Check the fit before putting your foot inThe heel of the orthotic should line up with the heel of the shoe — no gap, no overlap.

What's normal to feel

• Mild arch or foot sorenessEspecially in the first 1–2 weeks, as the arch takes on more support.
• Muscle tightness up the legCalves, knees, or hips can feel it too — your whole lower-extremity alignment is shifting slightly.
• All of this should ease as wear time increasesDiscomfort that's mild and gradually improving is expected. Discomfort that's severe or getting worse is not.

Your follow-up

• See us in 3 weeksWe'll check your progress and adjust the orthotics if any spot needs it — this is a normal, expected part of the process, not a sign something went wrong.

Soaking routine

• Epsom salt soak2–3 tablespoons dissolved in a basin of warm (not hot) water.
• Add Hibiclens3–4 squirts into the same basin for antiseptic cleansing.
• Soak 20 minutesOnly if your provider has confirmed there is no bone exposure at the wound base. If you can see or probe to bone, do not soak — call us instead.
• Pat dry gentlyUse a clean towel dedicated to the wound; don't rub.

Dressing & topical medication

• Apply your prescribed topicalBacitracin for basic coverage, or Santyl if prescribed — Santyl works enzymatically to help remove dead tissue, so apply it exactly as directed, only to the wound bed.
• Cover with a clean dressingChange at the frequency we've given you, or sooner if it becomes wet, dirty, or loose.
• Wash hands before and afterEvery dressing change, without exception.

Taking pressure off the wound

• Offload a wound on the bottom of your footUse your prescribed offloading device, boot, or shoe exactly as directed — continued pressure on a plantar wound is one of the main reasons ulcers don't close.
• Compression for a leg (venous) ulcerWear your prescribed compression wrap or stocking as directed, and elevate the leg above heart level when sitting.
• Limit standing and walking timeBoth pressure and prolonged dependency (leg hanging down) slow healing.

Watching for infection

• Check the wound at every dressing changeLook at color, size, drainage, and the skin around the edges — you'll notice a change fastest if you look consistently.
• A little clear or light yellow drainage can be normalThick, cloudy, green, or foul-smelling drainage is not — see red flags below.

Common triggers

• #1: DehydrationUric acid is dissolved in your blood and filtered by your kidneys. When you're dehydrated, uric acid becomes more concentrated and is more likely to crystallize — this is the single most common trigger we see, especially after illness, heat, alcohol, or a hard workout without enough fluid replacement.
• Dietary changesA sudden shift in either direction — a rich, purine-heavy meal (red meat, organ meats, certain seafood) or a crash diet/fast — can spike uric acid. Rapid weight loss releases purines as fat breaks down.
• Alcohol, especially beerBeer is high in purines from brewer's yeast and also impairs the kidney's ability to clear uric acid.
• Certain supplementsSome fish oil and omega-3 supplements are derived from shellfish sources and can carry purine loads high enough to provoke a flare in sensitive patients. Niacin (vitamin B3) can also raise uric acid levels. Check your supplement labels, and mention all supplements to us and your primary doctor.
• Certain medicationsDiuretics ("water pills") and low-dose aspirin can raise uric acid levels. Never stop a prescribed medication without talking to the doctor who prescribed it — ask us or them about alternatives if this is a recurring issue.
• Illness, surgery, or joint traumaPhysical stress on the body, including vomiting or diarrhea causing dehydration, can trigger a flare even without a dietary cause.

During a flare — what helps right now

• Hydrate aggressivelyIncrease your water intake substantially during a flare — aim for pale yellow urine as a rough guide. This is the single most useful thing you can do to help your kidneys flush uric acid.
• Tart cherry extractTart cherries are rich in anthocyanins, compounds with anti-inflammatory and uric-acid-lowering properties. Some patients use tart cherry juice or capsule extract during flares and for prevention — ask us or your primary doctor about a form and amount that fits your situation.
• Immobilize and take pressure off the jointRest the affected foot or ankle, avoid weight-bearing on it as much as possible, and use a cane, crutches, or supportive shoe if needed. Elevating the foot above heart level also helps reduce swelling.
• Take anti-inflammatory medication as directedIf we've prescribed or recommended something for an acute flare, take it exactly as instructed — this is different from the NSAID restrictions you may have seen on other cards in this guide.

Avoid ice on a suspected gout flare

• Do not ice the jointThis is different from a typical sprain or injury. Uric acid is less soluble in cold temperatures, so cooling the joint can promote faster crystal formation and make the flare worse rather than better. If you're unsure whether you're dealing with gout or a sprain, call us before icing.

Controlling uric acid long-term

• Two ways the body manages uric acidReducing how much your body produces, or increasing how much your kidneys excrete. Both can be addressed with lifestyle changes, and both can also be managed with prescription medication (such as allopurinol/febuxostat to reduce production, or probenecid to increase excretion) if your uric acid stays elevated — that's a conversation for your primary doctor or a rheumatologist for ongoing management.
• Stay consistently hydrated, not just during flaresDaily water intake is one of the most reliable ways to help your kidneys keep uric acid in check over time.
• Aim for gradual, steady weight lossIf weight loss is a goal, do it slowly. Rapid weight loss and crash diets are a known trigger for flares.
• Plant purines are not the same risk as animal purinesVegetables like spinach and asparagus contain purines but haven't been shown to raise gout risk the way meat and seafood purines do — you don't need to avoid them.

Foods & drinks to favor

• Water, throughout the day, every day
• Low-fat dairy products, which are associated with lower uric acid levels
• Cherries and tart cherry products
• Coffee, in moderation — some evidence links regular coffee intake with lower uric acid
• Vegetables, including purine-containing ones like spinach and asparagus

Foods & drinks to limit

• Organ meats (liver, kidney) and red meat in excess
• High-purine seafood — sardines, anchovies, mussels, scallops
• Beer and spirits; wine in moderation is a lower-risk choice if you drink
• Sugary sodas and anything with high-fructose corn syrup

Inspect your feet every day

• Use a mirror, or ask someone to check for youLook at the top, bottom, sides, heel, and between every toe. If sensation is reduced, your eyes are your early-warning system now — not your pain.
• Look forRedness, cuts, blisters, cracked or peeling skin (especially between toes), corns, calluses, ingrown nails, swelling, or any area that feels warmer than the rest of the foot.
• Check your socks and shoes tooBlood or drainage on a sock is sometimes the first sign of a wound you can't feel. Shake out and feel inside shoes before every wear for pebbles, seams, or debris.

Daily habits that protect you

• Wash daily with lukewarm waterTest temperature with your hand or a thermometer, never your foot. Dry thoroughly, especially between toes.
• Moisturize the tops and solesPrevents cracking — but skip between the toes, where excess moisture invites fungal infection.
• Fresh, well-fitted socks every daySeamless, moisture-wicking, and non-constricting (no tight elastic bands). Lighter colors make early drainage easier to spot.
• Trim nails straight acrossLeave corn, callus, and ingrown nail care to us — home tools on numb or poorly-healing skin are one of the most common ways small problems become serious.
• Shoes, alwaysEven indoors. Break in new shoes gradually — 1–2 hours at a time — while watching for red pressure spots.

Avoid

• Walking barefootIndoors or out — a step on something small can go unfelt.
• Heating pads or hot water bottlesReduced sensation means a burn can happen before you feel it.
• Self-treating corns, calluses, or ingrown nailsNo blades, no OTC acid pads — these can cause wounds that are hard to detect and slow to heal.
• SmokingFurther restricts the circulation your feet already depend on — see our Smoking & Your Feet card.

Blood sugar and infection are linked both ways

• Unexplained high blood sugar can be an early sign of infectionSometimes before you can see or feel anything wrong in the foot itself. If your numbers rise without a clear reason, check your feet the same day.
• And it runs the other way tooOnce an infection takes hold, it tends to push blood sugar higher, which further impairs your body's ability to fight it — a cycle that's much easier to interrupt early than late.
• Keep your primary doctor in the loopTell both us and your primary/endocrinology team if you notice a foot change and a blood sugar change around the same time.

See us regularly — not just when something's wrong

• A comprehensive diabetic foot exam at least once a year — more often if you've had a prior ulcer, poor circulation, or significant neuropathy. "Shoes and socks off" at every visit, even ones that aren't about your feet.

Make daily inspection a habit

• Check every part of both feetTop, bottom, heel, and between toes — use a mirror or a family member's help if bending or seeing is hard.
• Look, don't just feelA cut, blister, or splinter can sit painlessly for days with reduced sensation — visual inspection is what catches it.

Protect what you can't always feel

• Wear supportive, protective shoes at all timesIncluding indoors — bare or socked feet are far more likely to be injured unnoticed.
• Test water temperature with your hand or elbow firstNever with your feet — you may not feel water that's hot enough to burn.
• Take fall precautions seriouslyReduced sensation also affects balance and foot placement. Use handrails, keep walkways well lit, and go slowly on stairs and uneven ground.
• Manage the underlying causeBlood sugar control, B12 levels, or whatever condition is driving your neuropathy — controlling it can slow or sometimes improve nerve function.

Avoid

• Barefoot walking, indoors or out
• Heating pads or hot water bottles
• Self-treating any woundHave us look at it, even a small one.
• OTC acid-based corn/callus removersThese can cause a chemical burn you won't feel happening.
• Tight socks or shoesAnything that further restricts circulation to already-vulnerable nerves.

Treatment options

• We offer Neurogenx peripheral nerve stimulation therapy for neuropathy symptoms — ask us whether it's a fit for what you're experiencing.

How it affects your feet specifically

• Slower healingAfter surgery, an injection, or a procedure — reduced blood flow means slower delivery of the oxygen and nutrients healing requires.
• Higher infection riskImpaired white blood cell function makes it harder for your body to clear bacteria from a wound.
• Accelerated arterial diseaseSmoking is the single largest modifiable risk factor for peripheral arterial disease — see that card for how this connects.
• Reduced treatment effectivenessRegenerative treatments like PRP and EPAT/EMTT depend on healthy blood flow and cellular repair — both blunted by smoking.

Evidence-based ways to quit

• Nicotine replacement therapyPatch, gum, or lozenge — reduces withdrawal symptoms while you break the behavioral habit.
• Prescription medicationVarenicline or bupropion, prescribed and monitored by your primary doctor, roughly double quit-success rates compared to willpower alone.
• Behavioral counseling or a quitlineCombining counseling with medication is consistently more effective than either alone.
• Pick a quit date and identify your triggersStress, coffee, alcohol, certain routines — knowing yours in advance makes them easier to plan around.

Getting started

• 1-800-QUIT-NOWFree national quitline offering coaching and connection to local resources.
• Ask your primary doctor about medication optionsAnd feel free to bring it up with us too — we're glad to talk about it as part of your foot and ankle care.

While you're working on quitting

• Active smokers already carry elevated foot and circulation risk — the same daily inspection habit described on our Diabetic Foot Care and Neuropathy cards is worth adopting now, not just after you've quit.

Warning signs to watch for

• ClaudicationCramping or aching in the calf, thigh, or buttock that comes on with walking and eases with rest.
• Cold feet, especially compared to your hands
• Pale or bluish skin colorOn the feet or toes.
• Hair loss on the lower legs, or slow-growing, thickened toenails
• A wound on the toes or feet that heals slowly, or not at all
• Leg pain at rest or at nightThat improves when you let the leg hang off the edge of the bed — a sign of more advanced disease.

What helps

• Stop smokingThe single most impactful modifiable step — see our Smoking & Your Feet card.
• Supervised walking programsRegular, structured walking is proven to improve walking distance and encourage new collateral blood vessels over time.
• Manage blood pressure, cholesterol, and blood sugarWith your primary doctor — all three directly affect how fast plaque builds up.
• Take prescribed medicationsYour doctor may prescribe medication to improve blood flow or reduce clotting risk — take exactly as directed.
• Routine vascular checksWe may check pulses in your feet or refer you for ankle-brachial index (ABI) testing to measure circulation directly.

Avoid

• Smoking, in any form
• Tight socks, hosiery, or shoesAnything that further restricts already-limited circulation.
• Sitting for long periods with legs crossed
• Unprotected cold exposureCold further constricts already-narrowed vessels.
• Ignoring new leg pain with walkingEarly evaluation gives you the most treatment options.

How to get properly fitted

• Measure both feet, every timeMost people have one foot slightly larger than the other — always fit to the larger one.
• Shop later in the dayFeet swell throughout the day; a shoe that fits at 8am can feel tight by evening.
• Leave a thumb's-width of spaceBetween your longest toe and the end of the shoe, standing up.
• Wiggle-room in the toe boxYou should be able to move all five toes freely without the upper material pressing on them.
• Try both shoes on and actually walkNot just stand — walk around the store. Pain or rubbing during a walk test won't disappear with "breaking in."

Features worth looking for

• A firm, stable heel counterPress the back of the shoe — it shouldn't collapse easily. This is what keeps your heel from sliding.
• A removable insoleLets you swap in custom orthotics if we've prescribed them for you.
• A low, wide, stable heelUnder 1 inch is generally safer for your joints and balance than a higher, narrower heel.
• A bend point that matches your footThe shoe should flex at the ball of your foot, not in the middle of the arch.

Avoid

• Pointed toe boxes and high heels for extended wearThese are the shoes most consistently linked to bunions, hammertoes, and neuromas.
• Unsupportive flip-flops or sandals for long periodsFine for short trips, not for all-day wear or exercise.
• Buying a shoe that hurts hoping it will "break in"Minor stiffness easing over a few wears is normal; sharp pain, pinching, or rubbing is not.
• Trusting the size label aloneSizing varies by brand and even by style — always try before you buy.

When to replace your shoes

• Athletic shoesRoughly every 300–500 miles, or about 4–6 months of regular use — the cushioning breaks down long before the shoe looks worn out.
• Everyday shoesCheck for uneven sole wear, a leaning heel, or a collapsed heel counter — any of these change how your foot lands with every step.

If you have diabetes, neuropathy, or PAD

• Proper fit matters even more, since you may not feel early rubbing before it becomes a wound. Ask us about a professional fitting, and whether you qualify for a Medicare-covered pair of therapeutic diabetic shoes.

Non-surgical management

• A wider, roomier toe boxThe single most effective non-surgical step — see our Proper Footwear & Fit card for how to find one.
• Padding, spacers, or toe splintsCan reduce friction and rubbing over a prominent joint or curled toe.
• Custom orthoticsCan improve the underlying biomechanics driving the deformity and may slow how quickly it progresses.
• Activity modificationReducing time in triggering footwear or activities that load the area heavily.
• Watch the skin over the prominent areaEspecially important if you have diabetes or neuropathy — a bunion or hammertoe under constant shoe pressure is a common place for a wound to start unnoticed.

Avoid

• Narrow, pointed, or high-heeled shoesThese accelerate progression and increase pain over the deformity.
• Waiting and hoping it resolves on its ownThese deformities don't typically reverse without intervention — earlier conservative care generally means more options later.
• Self-adjusting with tight tape, rings, or online "bunion correctors"Without guidance, these can restrict circulation or irritate the skin without addressing the underlying cause.

When surgery becomes part of the conversation

• Persistent pain despite shoe changes and conservative care, difficulty finding any shoe that fits comfortably, or a deformity that's steadily worsening or affecting neighboring toes are all reasons to discuss surgical options with us. It's always an individualized decision based on your symptoms, goals, and overall health — not something we recommend automatically just because a bump is visible.