When Can I Drive After Foot and Ankle Surgery?

• There is no set number of weeks in law, and your surgeon cannot give you a date. In the UK, what matters is whether you can control the car and do an emergency stop as quickly as normal. Deciding this — and the legal responsibility — is down to you, the driver.
• The usual guidance of “about four weeks after an operation” is too short for surgery on the right foot or ankle. That figure comes from other types of surgery. Research on foot and ankle surgery shows something different.
• For surgery on the front of the right foot (forefoot), the research points to 6 to 9 weeks. After right bunion surgery, 85% of patients could brake safely at 6 weeks, and all of them could by 8 weeks.
• After a right ankle replacement, 92% could brake safely at 6 weeks, and all could by 9 weeks.
• Driving with your left foot instead is not a safe solution. In a driving simulator, people using their left foot were much slower to brake fully and to take their foot off the accelerator.
• In the UK there is something else the research does not cover: the clutch. If you drive a manual car, surgery on your left foot affects your driving too. Most of the research was done in countries where people mainly drive automatics, so it does not cover this.
• Most patients start driving sooner than they are advised to. In one study, only about 1 in 4 waited until the time their surgeon suggested.
• Whatever operation you have, you must tell your insurer. Your insurer may refuse to pay out if you were not fit to control the car.

“When can I drive?” is one of the first questions patients ask — often before they ask anything about the operation itself. It is also one of the hardest to answer simply, because the honest answer is that it depends on:

• which foot was operated on
• which operation you had
• how much pain you are in
• what you drive (manual or automatic)
• how well you are actually recovering

In this article I explain the law, what the research shows, and give you a practical checklist. That way, when you decide, you can base it on facts rather than hope.

Many people find this surprising, so here are the facts.

There is no law that sets a number of weeks. What the law does say is that you must be in full control of the car and able to do an emergency stop as quickly as normal. If you cannot do this and you drive anyway, you may be breaking the law — however long ago your operation was.

You do not usually need to tell the DVLA. For most foot and ankle operations, you only need to tell them if your surgeon asks you to, or if you still cannot drive three months after your operation.

You should tell your insurer. This is the step people most often forget. Insurers have different rules from the DVLA, and they may refuse a claim if you were not fit to control the car. Make a quick phone call to them before you start driving again.

The decision is yours, not your surgeon’s. I can tell you what the research says and how I think your recovery is going. But I cannot confirm that you will be safe to drive on a certain date — and no surgeon can. If you have an accident, “my surgeon said I could” is not a legal defence.

The research does not just ask patients how they feel. Instead, it measures brake reaction time — how long it takes from seeing a hazard to pressing the brake pedal all the way down. This is tested in a driving simulator and compared with people who have not had surgery.

In these studies, a braking time of 0.85 seconds or less counts as safe. People who have not had surgery are usually well under this.

This matters because the ankle does most of the work when you brake. Moving the ankle up and down, and having the strength to do so, matters more for braking than the knee or hip. That is why foot and ankle surgery affects driving more than you might expect from the size of the operation.

All the figures below are for surgery on the right foot — the foot you brake with.

Patients who passed at 6 weeks had an average braking time of about 0.63 seconds — well within the safe limit.

The more useful finding is who did not pass. In both the bunion and ankle replacement studies, patients who were not yet safe at 6 weeks had two things in common:

• More pain (a typical pain score of 3 out of 10, compared with 1, after ankle replacement; p = 0.022)
• A stiffer joint — less ability to point the foot down after ankle replacement (14° compared with 24°; p = 0.037), and less big toe movement after bunion surgery

This question comes up a lot, and it sounds sensible. But the research says no.

In one study of patients recovering from right foot or ankle surgery, 37% (more than 1 in 3) admitted driving with their left foot. The researchers then tested volunteers in a driving simulator to see whether this was actually safe.

It was not. Compared with normal right-foot driving, people using their left foot took much longer to brake fully (p = 0.019) and to take their foot off the accelerator (p = 0.034).

The same study also found that patients driving with a recently operated right foot went over the speed limit more often (p < 0.001) and hit more vehicles in the simulator (p < 0.026).

So it is not that one way is safe and the other is not. Both are less safe than normal. Driving with your left foot just swaps one problem for another — you are using a foot that has never learned where the pedals are, in a car designed for the right foot. It is not a safe way to get back on the road sooner.

Almost all of this research comes from countries where most cars are automatic. In the UK, manual cars are still common — and the published research does not take this into account.

If you drive a manual, surgery on your left foot or ankle also affects your driving. Using a clutch means pushing your foot down and lifting it up again and again, with control and some force. After left-sided surgery — such as an ankle fusion, flatfoot reconstruction or Achilles repair — this movement may be painful, weak, or not yet possible.

What this means for you:

• Left foot surgery does not automatically mean you can drive if your car is a manual. Be honest with yourself about whether you can use the clutch again and again in traffic — not just once on the driveway.
• If you can use an automatic car, borrowing one can help you get back on the road safely sooner after left foot surgery. It does not help after right foot surgery, because the problem is your braking foot.

Across all this research, one thing keeps coming up: patients drive earlier than they are told to.

A large review of 48 studies found that patients usually went back to driving before their braking speed had returned to normal on testing. The authors were clear: surgeons should be telling patients to wait longer than they do now.

Another survey found that, of patients who remembered being given advice about driving, only about 1 in 4 actually waited until the suggested time. Most went by how ready they felt rather than the advice they were given.

I understand why. Not being able to drive is a real problem — for work, for the school run, and for your independence. But you cannot judge this for yourself, because the problem is your reaction time — and you cannot feel that. Your foot can feel perfectly fine and still be two-tenths of a second slow. At 30 mph, two-tenths of a second is roughly another two and a half metres of road.

Before you drive for the first time, all of these should be true:

• You are out of the boot or cast (driving in one is not a good idea and may mean your insurance is not valid)
• You are no longer taking strong (opioid) painkillers such as codeine, tramadol or morphine
• You can stand and walk comfortably on the operated foot
• You have enough movement at the ankle and foot to work the pedals properly
• You could stamp hard on the brake right now without pain making you hesitate
• You have told your insurer
• Your surgeon or physiotherapist agrees you have reached this stage of recovery

When you do go out, keep your first drive short, on roads you know, and away from heavy traffic.

If you are planning foot or ankle surgery and need to work out how it will fit around driving, work and family, raise it at your consultation rather than afterwards. I am happy to talk through a realistic timeline for your operation and your situation.

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