Preoperative visits set the tone for surgical outcomes. They sharpen the diagnosis, align expectations, and prevent avoidable delays on the day of surgery. Over the last several years, our team of foot and ankle surgeons has shifted much of the pre-op process to telehealth without losing rigor. The change did not happen overnight. It took trial, refinement, and a few humbling missteps. Now, most patients reach the operating room better prepared, with fewer last-minute cancellations, and with a clearer understanding of their role in recovery.
This guide is a practical walk-through of how a foot and ankle surgery provider can make telehealth pre-op seamless. It reflects the day-to-day work of a board certified foot and ankle surgeon and a multidisciplinary team ranging from anesthesiology to rehabilitation. Whether you are preparing for a bunion correction, ankle ligament repair, Achilles reconstruction, hammertoe correction, plantar fasciitis release, ankle arthroscopy, or total ankle replacement, the essentials are the same: tight communication, thoughtful triage, reliable imaging, and a plan that respects each patient’s life outside the hospital.
What telehealth can handle well, and where in-person still wins
Telehealth solves predictable problems. Patients who commute long distances or juggle complex schedules can meet a foot and ankle specialist on a lunch break. Families can join from separate locations, which often uncovers caregiving details that matter after surgery. We can share imaging on screen, annotate deformity angles, and compare the operative plan against nonoperative options in real time. For most forefoot procedures and many soft-tissue ankle operations, a telehealth pre-op visit covers nearly everything: consent, medication management, deep vein thrombosis risk screening, durable medical equipment sizing, and home-safety planning.
There are limits. A podiatric surgeon cannot palpate a subtle peroneal tendon click or map a fleeting Tinel’s sign through video. Wounds, especially diabetic foot ulcers, deserve in-person assessment when there is any concern for soft tissue compromise or infection. Complex deformities such as severe cavovarus with long-standing ankle instability benefit from a hands-on exam. When in doubt, we sequence care: telehealth for education and logistics, a brief in-person focused exam to confirm physical findings, then a streamlined path to the operating room.
Building a pre-op telehealth workflow that actually works
The best workflows anticipate failure points. Early on, our no-show rate spiked because patients expected a simple phone call rather than a video visit that required a link, a camera check, and a quiet room. Now our staff sends a test link 48 hours in advance, confirms the device type, and reminds patients to have any braces or prior orthotics within reach. If a patient lacks reliable internet, we offer a hybrid: a telephone consult for consent and medical optimization, followed by a short in-person slot for targeted examination. The goal is not a perfect video connection, it is complete and safe preparation.
We also standardized what must be decided before the visit. If an ankle fracture surgeon needs updated radiographs to determine whether a percutaneous approach is possible, the imaging has to be in the chart 24 hours prior. If an Achilles tendon surgeon requires an ultrasound to evaluate tendon gaps, that order goes out a week ahead. The scheduler owns this timeline and escalates missing items quickly. Patients sense the difference when the whole team moves in sync.
What a telehealth pre-op visit covers, minute by minute
Every provider has a rhythm. Mine follows five beats: alignment, plan, risk, logistics, and recovery. Alignment verifies the diagnosis and confirms that surgery still makes sense for the patient’s goals. Plan describes the operation in plain language. Risk translates statistics into lived probabilities. Logistics settles everything that can derail a surgery date. Recovery sets expectations for the first two weeks, the first six weeks, and the finish line.
During alignment, I ask patients to describe their pain using a workday, a weekend, and a ten-minute walk to the mailbox. It paints a truer picture than a 0 to 10 scale. A sports foot and ankle surgeon will phrase it differently for an athlete: How does the ankle feel in the first quarter versus the fourth? Does cutting feel unstable, or is it pain-limited? These details sharpen the indication for an ankle ligament reconstruction versus continued rehab.
The plan discussion uses screen-sharing to show a standing AP radiograph for a bunion, an MRI coronal cut for an osteochondral lesion, or a CT for a complex calcaneal fracture. A foot and ankle orthopaedic surgeon can point to the exact angle of deformity or the cyst under the talar dome. Seeing the problem reframes abstract consent as a concrete solution. For minimally invasive foot surgeon cases, I demonstrate incision locations with a marker on my own foot so patients understand where they will feel tenderness.
Risk talks must be frank. A total ankle replacement surgeon will discuss loosening over 10 to 15 years and the possibility of revision; an ankle arthroscopy surgeon will mention nerve irritation, blood clots, expert foot care NJ and the rare need to convert to open surgery. I keep numbers realistic. For many elective foot operations, the infection risk hovers around 1 to 3 percent depending on comorbidities. Nonunion for certain midfoot fusions sits closer to 5 to 10 percent in smokers. Framing these as manageable risks, not inevitabilities, keeps trust intact.
Logistics includes medication holds, nicotine cessation, and equipment delivery. A diabetic foot surgeon will coordinate with endocrinology for perioperative insulin plans. Patients on GLP-1 agonists get tailored guidance, often pausing the weekly dose before anesthesia according to current anesthesia recommendations. Those using anticoagulants receive a bridging or hold plan from cardiology when appropriate. The foot and ankle surgery clinic ships a boot, knee scooter, or cast cover ahead of time so the first post-op shower does not turn into improvisation with trash bags and duct tape.
Recovery sets milestones: suture removal by 10 to 14 days, transition to partial weight-bearing at 2 to 6 weeks depending on the procedure, and return to running or court sports between 3 and 6 months for many ankle ligament reconstructions. For a heel surgery specialist managing calcaneal osteotomies, I emphasize the middle stretch from weeks 6 to 10 where enthusiasm surpasses tissue strength. Patients appreciate both optimism and speed bumps.
Imaging and labs: getting the right data without a second trip
Telehealth pre-op works only if the data travel well. Most cases need standing radiographs that capture true alignment. For hindfoot work, I request Harris axial views. For ankle instability, stress views still matter, particularly external rotation stress for syndesmotic injuries. A foot fracture surgeon may need oblique projections to chase a subtle fifth metatarsal nonunion. If those images are done outside our system, our team obtains digital DICOM files rather than screenshots to preserve detail.
MRI is invaluable for osteochondral lesions, peroneal tendons, and insertional Achilles tendinopathy with calcific spurs. In revision settings or complex deformity, a CT scan provides the roadmap for an orthopaedic foot and ankle surgeon planning hardware removal or 3D correction. For total ankle replacement, a weight-bearing CT when available clarifies joint orientation and helps template implant sizing. None of this requires an in-person pre-op if the image acquisition is done correctly and the files upload cleanly.
Pre-op labs follow anesthesia protocols and the patient’s medical profile. Hemoglobin A1c matters for a diabetic patient heading into fusion or total ankle; elevated levels correlate with infection risk and wound problems. Vitamin D deficiency comes up more than it should, especially in older adults with fractures or those planning arthrodesis. Correcting it is not a panacea, but it supports bone health. Nicotine testing is on the table for high-risk fusions. These conversations land better in telehealth when patients can open their medicine cabinet while we talk.
Consent that respects comprehension, not just signatures
A consent form does not guarantee understanding. I ask patients to explain the operation back to me in one or two sentences. A bunion surgery patient might say, You are cutting the bone, straightening it, and holding it with screws so it heals aligned. That statement tells me they know the gist. If they say, You are taking out the bunion bump, I spend another minute clarifying that we correct alignment first, remove the prominence second. This avoids the classic mismatch where a patient expects cosmetic smoothing while the surgeon aims for durable biomechanics.
We also talk about what happens if the plan changes in the operating room. For an ankle arthroscopy, a small osteochondral lesion might be debrided and microfractured, but a larger unstable fragment could require fixation. Setting that expectation ahead of time prevents surprise addenda after anesthesia. For a foot and ankle reconstruction specialist managing a flatfoot deformity, we review the possibility of adding a gastrocnemius recession if intraoperative dorsiflexion is limited. It is easier to consent for contingencies on a quiet video call than in a pre-op bay with monitors beeping.
Preparing the home, not just the hospital
The first ten days after foot or ankle surgery hinge more on home logistics than on incision size. Stairs, pets, carpet thresholds, and bathroom layout determine falls or friction. During telehealth, I ask to see the patient’s living space if they are comfortable panning the camera. We plan a sleeping spot on the first floor if necessary, arrange for a stable chair for sponge baths, and identify unreached items in the kitchen that need to move to waist height.
Pain control begins the night of surgery. Depending on the case, we prescribe a short supply of opioid medication, scheduled acetaminophen, and an NSAID if not contraindicated. Regional anesthesia can cover the first 12 to 24 hours, but rebound pain is predictable. I tell patients to start their oral regimen before sensation returns. A foot and ankle surgery provider who front-loads education on icing, limb elevation, and medication timing tends to hear fewer midnight calls.
When telehealth uncovers red flags
Every week or two, a telehealth pre-op reveals a reason to pause. A patient planning an ankle replacement might casually mention intermittent fevers or a recent dental abscess. An athlete with an ankle sprain scheduled for stabilization may describe calf tightness and shortness of breath after a long drive. These details change the plan. We postpone elective cases for unresolved infections and route urgent symptoms to emergency care. Telehealth does not dull clinical acumen. It widens the net for information that patients might forget to mention in a rushed clinic hallway.
Sometimes the red flag is social, not medical. If a patient cannot identify anyone who can stay the first night, or if they live alone up three flights of stairs with a 70-pound dog, we rethink the timeline or arrange short-term support. A foot and ankle surgical clinic succeeds when it looks beyond the incision.
Case snapshots: how telehealth shapes different surgeries
A bunion surgeon can complete most pre-op planning via video when the patient has recent weight-bearing X-rays. We review the hallux valgus angle and intermetatarsal angle, then match the procedure to deformity severity, whether a distal chevron, scarf, or Lapidus. The patient sees how hardware positions will feel when wearing shoes. We size a post-op boot remotely by shoe size and make sure toe spacers arrive with the boot.
For an Achilles tendon surgeon addressing insertional tendinopathy, ultrasound or MRI clarifies the degree of degeneration and Haglund prominence. During telehealth, I explain the split incision pattern, bone spur resection, and reattachment with suture anchors. We talk bluntly about recovery: the first two weeks non-weight-bearing, then progressive loading in a boot with heel wedges, and a realistic return to jogging around three months, with sprinting later.
An ankle instability surgeon planning a Broström repair or reconstruction can watch a patient demonstrate an at-home anterior drawer test on video, though the result is not definitive. We rely on the story of giving way during lateral cuts and failed rehab over 3 to 6 months. Telehealth handles brace prescriptions and home exercise previews that start pre-op and make the early post-op phase smoother.
For a total ankle replacement surgeon, telehealth sets expectations about implant longevity and activity limits. We discuss which activities make sense long-term. Golf and cycling are welcome, distance running is not. I share actual implant models on camera so patients understand component sizes and how alignment correction happens. We order a home safety check, coordinate with physical therapy, and, if needed, arrange a pre-op in-person exam to confirm pulses and skin integrity before we commit.
Coordinating with anesthesia, primary care, and specialists
A foot and ankle orthopedist is only as good as the team. Telehealth sped up how we coordinate with anesthesia. Nurse anesthetists or anesthesiologists hold their own virtual screening, reviewing airway history, prior anesthesia reactions, and medication holds. Primary care visits for medical clearance now happen by video as well, with lab orders routed locally. Cardiologists adjust anticoagulation plans without making the patient ping-pong between offices. The best part is not convenience, it is clarity. Everyone writes in the same shared plan, visible to the patient through the portal.
Diabetes management stands out. A diabetic foot surgeon knows that glycemic control drives outcomes for ulcers, Charcot reconstructions, and elective fusions. We aim for an A1c in the 7s when feasible. If the number sits higher, we weigh risks and benefits. Sometimes surgery is urgent, like a septic joint or a displaced fracture, and we proceed with inhaled insulin bridging in the hospital. Other times we delay to tighten control. Telehealth follow-ups every one to two weeks help patients stabilize before the operative date.
Documentation that saves you on surgery day
Good notes make smooth surgery days. The telehealth pre-op note should include the operative side, procedure names that match scheduling language, CPT codes if your system allows, implant preferences, and the post-op plan including weight-bearing status. It should also capture DME needs already ordered, pharmacy information verified, and an explicit statement of consent. When an ankle and foot surgeon arrives in the pre-op area, nothing should be left to memory. The scrub tech has the right anchors, the circulating nurse has compression devices in the room, and radiology knows if fluoroscopy is needed.
The two biggest mistakes we stopped making
The first mistake was underestimating the value of a real-time equipment test. A quick tech check by staff prevents late starts and rushed conversations. Patients feel cared for when they see we set them up for success. The second mistake was vague recovery timelines. Early on, we used soft phrases like a few weeks or around three months. Now we give ranges with decision points: non-weight-bearing for two weeks, transition to boot with partial weight-bearing as tolerated at two to four weeks, then advance based on X-rays at six weeks. Patients anchor to those markers and show up prepared to progress.
How patients can prepare for their telehealth pre-op
- Charge your device, test the camera and microphone, and position the camera so both you and your feet or ankles are visible while seated. Gather imaging CDs or ensure outside radiology has uploaded DICOM files; have your medication list, allergies, and past surgery dates handy. Place your boot, brace, orthotics, or athletic shoes nearby so we can evaluate fit or modifications on camera. Walk through your home before the visit and note any barriers like stairs, loose rugs, or narrow bathrooms you want to discuss. Invite a family member or friend who will help after surgery to join the call, even for the last 15 minutes.
What a top foot and ankle surgeon looks for in selection and timing
Titles like best foot and ankle surgeon or expert foot and ankle surgeon matter less than the surgeon’s judgment on timing. A seasoned foot and ankle surgical expert will recognize when to push for surgery and when to hold. For a high-level basketball player with chronic ankle instability and a sprain that never stabilizes after targeted rehab, earlier ligament reconstruction can save a season and protect cartilage. For a recreational runner with midfoot arthritis who tolerates activity on flat trails, we might lean on rocker-bottom shoes and injections to delay fusion until lifestyle changes or pain force the decision.
Telehealth serves that judgment by allowing more touchpoints. A follow-up video visit two weeks after a cortisone injection tells me more than a single snapshot in the office. If a patient walks better, sleeps better, and reduces pain medication, that informs whether we continue nonoperative care or set a date for a foot joint fusion. A foot and ankle medical specialist uses these interim data points to customize care.
Special cases that still warrant in-person clearance
Open wounds near the operative field call for direct assessment and sometimes debridement before elective procedures. Neurologic deficits that are evolving, such as new foot drop, merit a detailed exam. Severe peripheral arterial disease should be evaluated with pulse checks, ABI, or vascular consult before any surgery that risks wound healing. And while a minimally invasive ankle surgeon can perform many procedures through small portals, rigid deformities and prior scars sometimes steer us back to open techniques. Telehealth can identify these flags, but in-person confirmation protects outcomes.
Making post-op telehealth work just as well
Telehealth does not stop after surgery. Suture checks by video sound risky until you have done a few hundred. With good lighting, patients can show the incision, swelling pattern, and range of motion. If anything looks off, we bring them in quickly. Most routine questions, from nerve sensation to dressing changes after the first week, resolve well on screen. Physical therapists join a three-way call to align goals and constraints. For patients who fracture their timetable, like walking early on a fusion, a timely telehealth nudge can prevent a setback from becoming a failure.
The quiet advantages patients mention months later
Patients remember small moments. They recall that the foot & ankle doctor showed a simple elevation setup using two pillows and a rolled towel. They remember the ankle foot specialist reminding them to move the toes hourly to reduce swelling. They appreciate not having to drive an hour to ask if their bruising looks normal. These quiet advantages compound. A foot and ankle surgery practice that uses telehealth with intention builds trust one practical detail at a time.
Final thoughts from the operating room
If I had to choose one change that improved our service the most, it would be moving education and decision-making upstream through telehealth. By the time a patient arrives for a calcaneal osteotomy, a Broström repair, a bunion correction, or a total ankle replacement, we have already settled expectations, sized equipment, and rehearsed day-one recovery. That frees the team to focus on the craft of surgery. Patients feel ready rather than brave.
Telehealth does not replace the hand that checks capillary refill or the voice that reassures in the pre-op bay. It strengthens both. Used well, it gives a foot and ankle surgery provider the one resource that improves every outcome: time spent listening, explaining, and planning. And that, more than any incision choice or implant system, is what makes pre-op feel easy.