In 1999, I severed my right foot at the ankle and broke my lower leg in 80 places. I was in the hospital for 11 days. I bought a laptop after I was released and went back to my job site 2 weeks after it happened. With the laptop I did the paperwork I normally did every night and and made my calls. I did this because my leg would fill with lymph fluid that had no way to get back out because they could not reconnect the lymph system. (It is too fine a system. All they can do is hope some of it will reconnect on its own but it doesn't always happen.)
It would start pounding and throbbing by the afternoon every day. I had a hospital bed in my living room and I could elevate it and get the fluid back out.
At two months I went in for my first in office x-rays. The x-rays showed there was half inch gap between my leg bones and my ankle bone. (talus) My ankle bone had died. They prescribed a $5000 bone stimulator I would wrap around my foot.
When I went back with no improvement after months, he said if I didn't have a fusion I would be in a lot of pain within a year. They used a cadaver bone as a shim and 3" titanium screws and the bone grows and fills in the gaps around the breaks. You lose ALL use of your ankle motion in every direction. I've found it's like walking on a pole with a foot hanging off it. It's very tough walking on angles or uneven surfaces like rocks, sand, or stairs.
After 3 months of physical therapy 3 mornings a week in a cast before work, and, custom made work boots, I still couldn't push off with the ball of my foot.
We decided to go in again to reset the angle of the fusion. The idea was to leave the ankle bone alone and fuse the bones forward of it, but, when he got in there, he decided to redo the ankle bone where it met the leg bone. After he takes it apart and shapes the bone to the new angle he discovers the screws won't hold. He puts 5 titanium rods through my leg bone and ankle bone that were clamped to graphite rods outside my leg. I now have 10 open wounds to dress twice a day for 5 months with physical therapy for another 3 months. (I had requested an epidural block instead of general and because he ran into this problem causing the surgery run long after the screws didn't hold, I was awake the second half of the surgery. I looked up at the anesthesiologist and said, am I supposed to be feeling this? :-) Evidently, they can't give you any more when they do an epidural.)
3 YEARS, 5 Surgeries and on crutches and in a wheelchair the entire time.
You know what I didn't do that whole time? QUIT SMOKING
It takes some powerful denial to ignore the Dr.
Did my continued smoking prevent proper healing? More than likely.
My foot starts throbbing every day about 1pm.
The moral of the story is listen to your Dr. when they tell you smoking inhibits healing. The carbon monoxide in the bloodstream robs the injured areas of needed healing oxygen.