Venous thromboembolism following major orthopedic procedures of the hip and knee is well documented and patients are therefore routinely prophylaxed following these proximal lower extremity procedures. In contrast, foot and ankle surgery is considered by most health care professionals to be a low-risk procedure for the development of venous thromboembolism. As a result, pharmacologic deep venous thrombosis prophylaxis is rarely administered. This postoperative practice is supported by the literature regarding deep venous thrombosis following foot and ankle surgery. In this article, we review the risk factors and explore the occurrence of thromboembolism after foot and ankle surgery in the literature. We also present our retrospective study of patients who developed venous thromboembolism after forefoot, midfoot, hindfoot, and ankle procedures. Over the course of 1.5 years, 4 of a consecutive series of 1000 patients (0.4%) developed a deep venous thrombolism and 3 of 1000 (0.3%) developed nonfatal pulmonary emboli. In our series, each of our patients who developed venous thromboembolism had at least 2 identifiable risk factors. The incidence of venous thromboembolism following foot and ankle surgery is rare (less than 1%), and the need for routine propylaxis postoperatively is not supported by any high level of evidence studies.
Level of clinical evidence: 4.