Smoking and foot and ankle surgery

Smoking and foot and ankle surgery


The aim of this leaflet is NOT to provide definitive advice on how to give up smoking, nor does it cover all of the health risks associated with smoking.

We will explain in this leaflet why smoking and nicotine is harmful when considering foot and ankle surgery.

Why did my surgeon ask me if I smoke?

If an option for your treatment is surgery, we must balance the risks against benefits. Aside from the general health risks of smoking, smoking negatively affects the outcome of surgery in a number of ways.

How does smoking affect the anaesthetic for surgery?

Although complications during an anaesthetic are very rare, the risks of all types of anaesthetic (including ‘spinal’ or ‘epidural’ anaesthetic) are increased in smokers. Smoking causes heart and lung disease, which can result in serious complications.

How does smoking and nicotine affect the recovery from foot surgery?

Being a smoker will not change how we do the surgery, but reduces the likelihood of surgery being offered to you, as the risks are higher.

Smoking and nicotine harms the body’s ability to heal wounds and has been shown to prevent bones healing.

The risk of wound breakdown and infection is more than doubled in smokers. Wound problems often need further treatment such as the use of antibiotics or further surgery. Wound infections can also result in less satisfactory long-term outcomes.

Failure of the bones to heal properly or ‘non-union’ is increased five-fold in smokers. If the operation involves cutting or fusing bones together, smoking will increase the chance of failure, which may again require further operations.

The risks can be returned to normal if you stop smoking before surgery.

Smoking related risks and complications of foot and ankle surgery:

  • increased risk from the anaesthetic
  • slower recovery from the anaesthetic
  • increased risk of illness directly after the operation including pneumonia and pulmonary embolus (a blood clot on the lung)
  • wound healing problems
  • failure of the bones to heal

Our current guidelines

You will be assessed on an individual basis as to your need for surgery.
We do not, as a rule, offer elective, or planned, surgery to people who continue to smoke.

You should give up smoking for a period of three months before planned surgery. This includes the use of nicotine supplementation, such as patches and gum.

Where to go for help

Your GP can help you assess the best way for you to give up smoking.

Smokefree NHS’ also provides expert advice and support including Apps, emails and texts.