Many people put off foot and ankle surgery because they are worried about pain. It helps to know what really happens. Pain relief today is very good, and most people find it much easier than they expected.

You have choices. You can be put to sleep (general anaesthetic), numbed from the waist down (spinal anaesthetic), or have just your leg numbed (nerve block). These are often used together. For most foot and ankle operations, a nerve block is the main form of pain relief, whatever else you have.

A nerve block keeps your foot numb and almost pain-free for about 24 to 36 hours. In one good-quality study, patients felt nothing at all in their foot for an average of 31.7 hours.

The block covers the time when pain would normally be at its worst. By the time feeling comes back, the worst is over. From then on, the pain gets steadily better, not worse.

Pain relief works best in layers, not as a single medicine: the block, paracetamol, anti-inflammatories, a few days of stronger painkillers if needed, and — very importantly — keeping your foot raised.

In clinic, people ask about scars, time off work and whether they will be able to walk. But often the real question is: how much is this going to hurt?

It is a fair question, and it deserves an honest answer, not just comforting words. The truth is that foot and ankle surgery has a reputation for being painful. This is partly fair, but mostly out of date. The foot has lots of nerves. It is also the lowest part of your body, so fluid collects there, which causes swelling and throbbing. But the way we give anaesthetics has improved a great deal, and most people are surprised by how manageable the pain is.

You will decide these with your anaesthetist (the doctor who gives the anaesthetic), usually on the day of surgery. There is nearly always more than one good choice.

In Mr Welck’s practice, the most common choice is a general anaesthetic plus a nerve block. The general anaesthetic keeps you asleep during the operation. The block then keeps you comfortable for about the first day and a half afterwards.

For foot and ankle surgery, the usual block is called a popliteal sciatic nerve block. Numbing medicine is injected around the sciatic nerve behind the knee. This nerve gives feeling to almost the whole foot. It is often combined with a second injection, called a saphenous nerve block, to numb the inner side of the ankle, which the sciatic nerve does not reach.

The anaesthetist uses an ultrasound scanner, so they can see the nerve and where the numbing medicine goes. It takes a few minutes and is usually done once you are asleep or drowsy.

This is the number that matters most, and there is good research on it.

A 2025 study, in which patients were put into groups at random, measured the time from when the block was finished until patients first felt any pain in the foot:¹

So, for most people, the answer is 24 to 36 hours. Some people will have a bit less, and some a bit more.

The same study found something useful. The weaker dose gave exactly the same length of pain relief, but caused much less muscle weakness in the first 12 hours. This means your foot feels less heavy and floppy, with no loss of comfort.

Yes. Adding a steroid medicine called dexamethasone makes a block last longer. In one study, the average time with pain relief was:⁵

• 17.6 hours with numbing medicine alone
• 26.2 hours with dexamethasone given into a vein (through a drip)
• 27.9 hours with dexamethasone injected around the nerve

Giving it through a drip worked just as well as injecting it around the nerve. This is reassuring, because it means it does not need to be added to the nerve injection.

Many people are not expecting this, so it is worth explaining.

Your foot and lower leg will be completely numb and feel heavy and strange. You will not be able to wiggle your toes or move your ankle. Many people find this odd rather than painful — it can feel as though the leg does not belong to you. This is entirely normal and it is temporary.

What this means for you:

• You cannot feel if you hurt it. Do not test the foot, do not let it bang against anything, and do not put weight on it unless you have been told you can.
• Keep it raised from the start. Do not wait until it hurts.
• Protect it from heat and cold. Numb skin can burn without you noticing.
• Feeling comes back slowly, usually as pins and needles first, then an ache.

This is the part that catches people out, so it is important to be honest about it.

When the block wears off, feeling comes back fairly quickly — often over an hour or two. If you have not taken any other painkillers, the pain can come on suddenly. Doctors call this rebound pain, and it is common. A large study of 1,365 foot and ankle patients found that about half had a big spike in pain within 48 hours of having a single block injection.²

The researchers also tried to predict who would get it, using things like age, sex, type of surgery and type of anaesthetic — but they could not do this well. This matters: because we cannot tell who will get it, everyone should be ready for it.

Two things help put this in perspective.

First, this is a normal stage of recovery, not a new injury. Your foot has not suddenly got worse. You are feeling the pain that was there all along, arriving all at once instead of slowly. It is at its worst for a few hours and then settles.

Second — and this is the key point — the block has got you through the worst of it. Pain after surgery is at its worst in the first 24 hours. By the time the block wears off, that is behind you. From then on, the pain gets less. Almost every patient tells me afterwards that, after this point, the pain was never as bad as they had feared.

Not when it starts hurting. Before. From the evening of surgery, take the paracetamol and anti-inflammatory you have been given, at regular set times, even if you feel you do not need them. The aim is to have pain relief already working in your body when feeling returns, so the pain builds up gently rather than hitting you all at once.

This is not just sensible advice — it has been tested. A study of 95 patients having bone surgery around the ankle compared people who started extra pain relief before the rebound pain began with people who waited.³ The group who started early had:

• Clearly lower pain scores at 24 hours (a difference unlikely to be down to chance)
• Every patient happy with their pain control, while several people in the group who waited were not
• On average, only 0.75 mg of strong painkiller (opioid) per person over three days, compared with 11.40 mg in the group who waited

That is about 15 times less strong painkiller, just from taking tablets at the right time.

Pain relief after foot and ankle surgery works best when several things are used together, rather than relying on just one.

Many people — including some doctors — believe that operations on the back of the foot (hindfoot) and ankle are much more painful than those on the front of the foot (forefoot), and that big operations mean big pain.

A study that followed 140 patients having planned foot and ankle surgery measured their pain immediately after surgery, at 6 hours and at 24 hours, and found no real difference between operations on the front or middle of the foot and those on the back of the foot at any of these times.⁴

The size of the operation does not tell you much about how much it will hurt. Bunion surgery is not a “minor” operation from your foot’s point of view, and an ankle fusion does not have to be an ordeal. What matters much more is how good the block is, when you take your medicines, and how well you keep your foot raised.

Most of Mr Welck’s patients have very little pain after surgery, thanks to nerve blocks given by highly specialised anaesthetists and careful use of pain medicines afterwards.

If you are thinking about foot or ankle surgery and worry about pain is holding you back, please do ask me about it. I am happy to explain what the anaesthetic and recovery would really involve for your operation, before you decide anything.

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