It’s a nice day in NYC, the bunion, hammertoe, heel spur, or other foot and ankle surgery is done, and the dressings have been removed, and surprise- your gender has been reassigned!  This probably has not happened within the walls of my NYC podiatry office, but what has happened is patients’ surprise at the aesthetically pleasing scar on the foot.  The edges are lined up evenly, and the butterfly strips are placed just right, thus concealing the dissolving stitches underneath.  Last week we discussed surgical incision planning, this week we will discuss what happens in the weeks and months after the foot and ankle surgery wound is closed and healing.

First, the basics (zzzz…)

Skin wounds heal in three phases, which are designated as the inflammatory, repair and remodeling phases.  In the inflammatory phase, the skin edges are sealed shut, and a bridge is formed between the edges.  The second phase begins after about a week, and during this phase the body completes the seal of the skin edges, once again restoring the semipermeable barrier of our largest organ- the skin (sorry Carlos Danger).  Two to three weeks after foot and ankle surgery the body enters the remodeling phase.  This is the slowest phase of healing, during which time, as the name suggests, the scar is remodeled to a point close to the original structure.  During the first two phases, the scar usually looks great- thin, light, and barely perceptible.  However, the during the remodeling phase the scar typically becomes a bit thicker and darker due to the intense healing activity at work.  After this phase a scar will once again become lighter, thinner and more cosmetic- in most cases.

So what do I do with this scar of mine?

In those cases in which the scar heals less than cosmetically, there are treatment options.  The most important treatment is often that which heals most wounds- time.  As I tell my NYC podiatry patients, the body knows what to do, we just have to let it happen.  In addition to time, there are a few over the counter products available specifically for treatment of thick scars.  There is some evidence that these products work, and I have anecdotally heard good feedback from my NYC podiatry patients.  Other topical preparations such as Vitamin E, shea butter, cocoa butter and petroleum jelly have all demonstrated some efficacy in treatment of thick scars.  Silicone based bandages, which work by flattening out the scar, are available over the counter.  And if all else fails, localized injections of corticosteroid into the scar can reduce thickness and improve the cosmetics.

So if you’ve had foot or ankle surgery in NYC, or anywhere else, and are concerned about the scar, fret not young grasshopper.  Stop in to your local neighborhood NYC podiatrist for some loving care.

See you in the office.

Ernest Isaacson