Name of the Procedure:

Incision and Drainage Below Fascia, with or without Tendon Sheath Involvement, Foot; Single Bursal Space. Commonly referred to as I&D of foot bursa.

Summary

Incision and drainage (I&D) below the fascia in the foot involves making a surgical incision to drain pus or fluid from an infected or inflamed bursal space, which may or may not involve the surrounding tendon sheath.

Purpose

The procedure is intended to relieve pain, reduce infection, and prevent the spread of infection in the foot. The primary goal is to remove accumulated fluid or pus to aid in healing and prevent further complications.

Indications

• Severe pain and swelling in the foot.
• Infection or abscess in the bursal space.
• Presence of pus, redness, and warmth indicating an infection.
• Failed response to conservative treatments like antibiotics.

Preparation

• The patient may be instructed to fast for several hours before the procedure.
• Adjust or pause certain medications as advised by the healthcare provider.
• Pre-procedure diagnostic tests such as blood tests or imaging (e.g., X-ray, ultrasound) may be required.

Procedure Description

1. The patient is positioned comfortably, and the affected foot is sterilized with an antiseptic solution.
2. Local anesthesia is administered to numb the area.
3. A small incision is made over the infected bursal space.
4. Pus or fluid is drained from the infected area.
5. If necessary, the surgeon will explore the surrounding tissues and tendon sheath for additional infection.
6. The area is thoroughly irrigated to cleanse any remaining debris or bacteria.
7. A sterile dressing is applied to cover the incision site.

Duration

Typically, the procedure takes about 30 minutes to an hour, depending on the complexity.

Setting

The procedure is usually performed in an outpatient clinic or surgical center.

Personnel

• Surgeon or podiatric surgeon
• Surgical nurse
• Anesthesiologist or nurse anesthetist (if sedation is used)

Risks and Complications

• Infection
• Bleeding
• Damage to surrounding structures or nerves
• Scarring
• Recurrence of infection or abscess
• Prolonged pain or swelling

Benefits

• Relief of pain and reduction of infection.
• Prevention of infection spread and potential complications.
• Improved mobility and function of the foot.

Recovery

• The patient may need to keep the foot elevated and limit weight-bearing activities for a few days.
• Pain management may include over-the-counter pain relievers or prescribed medications.
• Dressings should be changed as instructed, and follow-up appointments are crucial for monitoring healing.
• Complete recovery can take a few weeks, depending on the severity of the initial infection and the patient's overall health.

Alternatives

• Antibiotic therapy alone (may be less effective if pus is present).
• Aspiration (drawing out fluid with a syringe, less invasive but may not be sufficient for severe cases).
• Conservative treatments like rest, ice, and elevation.

Patient Experience

During the procedure, patients will feel little to no pain due to local anesthesia. Mild discomfort or pressure may be experienced. Post-procedure, there may be some pain and swelling managed with medications and rest. Patients should follow the healthcare provider's instructions for optimal recovery.