SLR - May 2019 - Sokieu Mach

Patient Safety: Driving After Foot and Ankle Surgery

Reference: Caroll, J, McClain WD, Dowd TC. Patient Safety: Driving After Foot and Ankle Surgery. Orthop Clin North Am. 2018 Oct;49(4):527–539.

Scientific Literature Review

Reviewed By: Sokieu Mach, DPM
Residency Program: Phoenixville Residency, Phoenixville, PA

Podiatric Relevance: Nearly all foot and ankle surgeries involve some form of immobilization, such as splints, casts, surgical shoes and walking boots. It is imperative for the surgeon to educate their postoperative patients on when it is safe to return to driving. The surgeon must consider the patient’s ability to return to driving as multifactorial and based on considerations, such as procedure performed, timing of procedure, immobilization, comorbidities, medications, personal driving capabilities and habits. The decision to return to driving should be based on clinical considerations in addition to state laws and insurance policy limitations. Several prior studies have examined the impact of immobilization after surgery on braking time. This article reviews evidence available regarding foot and ankle surgery and driving.

Methods: This is a level V article reviewing available evidence from existing literature regarding driving and foot and ankle surgery. This article explores some of the medical and legal responsibilities of physicians and summarizes insurance consensus. Additionally, the authors consider the impact of opioid use, obesity, obstructive sleep apnea, age and distractions on driving.

Results: Most states do not have regulations about driving with a lower-extremity cast, walking boot or even after foot and ankle surgery. Additionally, very few states require physicians to report patients with impaired driving function. The consensus from insurance companies is that the ability to return to driving depends on the patient even though the physician’s opinion plays a role. Insurers are able to refuse coverage when a driver was involved in an accident while still recovering from an injury or operation. Studies show that patients should return to driving two weeks after right ankle arthroscopy, six to eight weeks after right first metatarsal osteotomies and nine weeks following surgical fixation of a displaced right ankle fracture. Other studies showed total brake response time while wearing a controlled-ankle-motion boot, cast, surgical shoe or using a left-foot driving adapter was significantly increased compared with normal footwear. Opioid usage, obesity, sleep apnea, increasing age and driving distractions all increase the risk of motor vehicle accidents.

Conclusions: In addition to counseling patients on the importance of not driving with lower-extremity immobilization, surgeons must consider the use of narcotics postoperatively, should be aware that the obese and aging patient is at a higher risk, should educate patients with sleep apnea on the importance of adhering to treatment and should have awareness of potential driving distractions. Foot and ankle surgeons should have an improved understanding of these topics to enhance their ability to counsel patients and optimize their safety on and off the road. Physicians may be held liable if they fail to correctly advise patients not to drive. Further studies are needed to assess each postoperative patient type individually. 

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