Recovery from foot and ankle surgery takes longer than most people are told. Swelling and stiffness can take 9 to 12 months to settle, especially after bigger operations. Still being uncomfortable at four months is common. On its own, it does not mean something has gone wrong.

But pain that carries on always has a reason. It may be time, healing, the way the foot lines up, an irritated nerve, a diagnosis that missed something, or a problem with the metalwork or implant. These causes can be told apart from one another.

The commonest reason for a disappointing result is a diagnosis that missed something, not a badly performed operation. If the pain was never coming from the part that was operated on, even a perfect operation will not fix it. This is why it is so important to work out exactly what is causing the pain before any surgery.

The way the foot lines up is the thing most often missed. Standing X-rays are flat, two-dimensional pictures. A weight-bearing CT scan shows the foot in 3D while you stand on it. In one study of people with severe ankle arthritis, 46% had a second problem lower down in the foot that a normal X-ray does not measure.

How you feel in yourself genuinely affects recovery, and this does not mean the pain is imagined. People who are very fearful and negative about their pain before surgery tend to do less well a year later, and this can be treated. Pain that has been severe for a long time also does not disappear overnight.

It is reasonable to ask for a second opinion at any point. It often confirms that the original plan was right, which is a useful answer in itself. And more surgery is not always the right next step.

Before anything else, it helps to know what to expect. A great deal of unnecessary worry comes from a recovery timeline that was never explained properly.

Foot and ankle surgery takes longer to recover from than most people expect. The foot is the furthest part of the body from the heart, so swelling is slow to drain away, and bone carries on healing and reshaping for a year or more. So:

• Swelling that is worse by the end of the day is normal for 6 to 12 months
• Stiffness in an operated joint improves slowly, and the joint may never bend as far as it did before — sometimes that is deliberate
• Aching after a long day, or in cold weather, is common well into the first year
• A tender scar and patchy numbness around it are normal, and usually improve
• A worse month after a good month is normal. Recovery is not a straight line

What is not normal, at any stage: pain that is getting worse rather than settling; pain that wakes you at night; new redness, heat, spreading swelling or fluid leaking from the wound; suddenly not being able to use the foot; or pain far worse than you would expect for the operation you had. If any of these happen, contact your surgical team promptly rather than waiting for your next appointment. Knowing what to expect from the start makes a real difference.

These reasons are not all equally common, and they can be told apart from one another. That is the whole point of a proper reassessment.

1. It is simply too early

This is the most frequent explanation, and the easiest to dismiss because it can feel like being fobbed off. Bone healing, soft tissue settling and swelling going down all take longer than most information leaflets suggest.

2. The bone has not healed

If you had a fusion, or a bone was cut and repositioned (an osteotomy), the bone has to knit together. When it does not, this is called a non-union. It usually causes deep pain that comes on with activity and does not steadily improve. It is diagnosed on an X-ray or CT scan.

Non-union is much more likely in smokers. Stopping smoking is the single biggest thing you can do yourself to change the result.

3. The alignment was not fully corrected — or the problem was somewhere else

The foot works as a linked chain. Correcting one part can be undone by a problem above or below it, and a problem that looks isolated on a standing X-ray often is not.

This is where 3D scans change the picture. A study of 72 people with severe ankle arthritis after an injury compared standard standing X-ray measurements with automatic 3D measurements from a weight-bearing CT scan. The 3D measurements were more reliable. In 46% of people, the foot below the ankle had tilted to balance out a problem above it. In another third, there was no such balancing, or the problem was getting worse.

If that whole-leg picture was not mapped out before the first operation, it is a common reason why a well-performed operation does not give the relief expected.

4. The original diagnosis missed something

In my experience this is the commonest reason for a disappointing result, and it is worth saying plainly because it is rarely discussed.

The foot and ankle pack a lot of structures into a small space, and more than one of them can hurt at the same time. A bunion can be corrected perfectly while the real source of pain was arthritis in the joint next door. Heel pain can be treated as plantar fasciitis for two years when all along it was a trapped nerve or a stress fracture.

The uncomfortable truth is that a failed operation and a failed diagnosis look identical from the outside — and the answer to the second one is not more surgery on the same part. Mr Welck often uses diagnostic injections before deciding on a surgical plan, to be sure where the pain is really coming from.

5. Nerve pain

Small nerves just under the skin cross most surgical cuts in the foot and ankle. They can be stretched, caught up in scar tissue or trapped by a stitch.

Nerve pain feels different from mechanical pain: burning, electric, shooting, or an area where the skin feels altered. It is often worse at night and worse at rest, which is the opposite of mechanical pain. It sometimes settles with time, desensitisation exercises and nerve pain medication, and sometimes needs an operation to free a trapped nerve.

6. Complex regional pain syndrome (CRPS)

This is uncommon, but it matters because picking it up early makes a difference. CRPS causes pain far worse than expected for the injury or operation, along with changes in skin temperature and colour, swelling, pain from the lightest touch, changes in sweating and a very stiff foot.

The foot and ankle is the second most commonly affected area after the hand and wrist, making up about one in five cases in one large study, and about one in six cases follow surgery with no injury beforehand. Being in a cast for a long time is a known risk factor.

There is also something that may help prevent it. A study of 329 people having foot and ankle surgery found that taking 1 g of vitamin C a day for 40 days after the operation was linked to a much lower risk of CRPS. It is cheap and low-risk. Not every hospital uses it routinely, so it is worth asking about before your operation rather than after.

7. The metalwork is rubbing

Plates and screws sit under thin skin in much of the foot and ankle. They can become prominent, catch on shoes or rub on a tendon. This causes pain in one specific spot, which you can bring on by pressing on it, and which is usually worse in certain footwear.

Taking out metalwork that is causing symptoms is a small operation and often works very well. It is not completely risk-free, and it is usually left until the bone has fully healed.

8. The implant itself

If a joint was replaced or resurfaced, the implant is a mechanical device and can loosen, sink into the bone or wear out. Pain that had settled and then came back, or a change in how the joint feels when you stand on it, points to this. It is checked with X-rays and often a CT scan.

The two earlier posts in this series on ankle replacement longevity and the Cartiva recall cover this in more detail.

9. Stiffness, weakness and being out of condition

Sometimes the operation worked, the bone healed and the alignment is good — but the leg simply has not been built back up. Calf strength takes many months to rebuild after time in a boot, and a weak calf changes how the whole foot takes your weight.

This is one of the more encouraging answers, because it responds to work rather than to another operation.

10. When the pain system itself has changed

This needs careful explaining, because it is easily heard as “it is all in my head”. It is not. The pain is completely real and you genuinely feel it.

What the evidence shows is that how we think and feel about pain measurably affects how much pain and difficulty a person has for the same amount of damage to the tissues:

• One study followed people having foot and ankle reconstruction. Those who were most fearful and negative about their pain before surgery had clearly worse scores a year later for pain, daily activities and quality of life.
• A study of people an average of 24 years after ankle fracture surgery found that how they rated their foot had little to do with what the scans showed. It related far more to physical weakness and to low mood.
• In Achilles tendon problems, a stronger fear of moving or re-injuring the tendon is linked to worse symptoms and worse physical performance.

The important point is that these things can be changed. Fearful thinking about pain responds to psychological support; fear of movement responds to gradual, supervised exercise; low mood responds to treatment. Identifying them is not a way of dismissing your pain — it treats a part of it that repeat surgery cannot reach. One way to think about it is that pain which has been severe for a long time turns up the volume on the body’s pain pathways. Surgery cannot always fix that, so it may need calming down before surgery can work.

A useful second opinion is more than a quick look at your scar. It should include:

• A full history, including what the pain was like before the operation, and whether the pain now is the same, different, or in a different place. This alone often gives the answer.
• Your operation notes and previous scans. What was actually done matters, and it is often different from what people remember being told.
• An examination of the whole leg, not just the operated part — including how tight your calf is, how your heel lines up, and the joints above and below.
• X-rays taken standing up, and where alignment or arthritis is in question, a weight-bearing CT scan, which measures the 3D shape of the foot while you stand on it rather than lying down.
• An MRI scan if a problem with soft tissue, a nerve or the inside of a bone is suspected, or a CT scan to check whether the bone has healed.
• A diagnostic injection in some cases. Numbing one specific structure and seeing whether the pain goes is the most direct way to find the source.

You do not need permission, and asking for one is not a criticism of your surgeon. Good reasons include:

• Pain that is not following the expected pattern by around six months, or that is getting worse rather than better at any stage
• Being told nothing more can be done, while you are still limited in what you can do
• Being offered more surgery and wanting to understand the alternatives before you agree
• A diagnosis that has never quite fitted your symptoms
• Losing confidence in the plan — which matters, because rehabilitation depends on believing in what you are doing

Sometimes a fresh pair of eyes on the problem really helps, especially if you feel you are not making progress.

A second opinion is only as good as the information available. Please bring:

• All previous scans and X-rays — the actual images, not just the reports. Most hospitals will give you these on a disc or a download link
• Operation notes for every relevant procedure
• Clinic letters and physiotherapy notes
• A list of everything that has been tried, including injections, insoles, physiotherapy and medication, and what each one achieved
• A clear idea of what you want — pain relief, getting back to a particular activity, or simply an explanation

It is worth being straightforward about the possible outcomes, because people often expect it to lead to another operation.

Often it confirms that the original plan was right and that more time is needed. That is a genuinely valuable answer — it turns anxious waiting into informed waiting, and people usually get on better with their rehabilitation afterwards.

Sometimes it finds a missed or additional diagnosis, which changes the treatment completely and may not involve surgery at all.

Sometimes it finds a problem that further surgery can fix — a bone that has not healed, a bone that healed in the wrong position, a deformity that is still there, a loose implant or a trapped nerve.

And sometimes the honest answer is that more surgery is unlikely to help. That is a legitimate and important conclusion. Revision surgery is harder than the first operation and the results are less predictable, and operating on pain without a clear structural target is one of the surest ways to make someone worse. A surgeon who tells you this is doing their job.

How long should pain last after foot or ankle surgery?

Longer than most people expect. Swelling and discomfort at the end of the day are common for 6 to 12 months, and you often do not feel the full benefit until around a year. Pain that is getting worse, waking you at night, or coming with redness, heat or fluid leaking from the wound is different and should be reported promptly.

Does a second opinion mean I am criticising my surgeon?

No, and most surgeons see it as entirely reasonable. Complicated or long-lasting problems benefit from another view, and a second opinion often confirms the original plan. Mr Welck and the team at the Royal National Orthopaedic Hospital do a lot of second opinions and revision operations, and work closely with the original surgeon where appropriate. There is no blame — not every operation turns out as hoped, for a whole range of reasons.

Will I need another operation?

Not necessarily. Many causes of ongoing pain — being out of condition, a sensitive nerve, unfinished rehabilitation, or simply time — do not need surgery. Where there is a clear structural problem, further surgery may help.

What is the difference between nerve pain and mechanical pain?

Mechanical pain is usually worse with activity and better with rest. Nerve pain tends to burn, shoot or tingle, is often worse at night and at rest, and may come with numbness or extra sensitivity in one area.

What is CRPS and how would I know?

Complex regional pain syndrome causes pain far worse than expected for the injury or operation, along with changes in skin colour and temperature, swelling, pain from the lightest touch and stiffness. It needs to be picked up early and seen by a specialist. The foot and ankle is the second most commonly affected area after the hand.

Can vitamin C prevent CRPS?

A study of 329 people having foot and ankle surgery found that 1 g a day for 40 days after the operation was linked to a lower risk. It is cheap and low-risk, though not every hospital does this routinely — worth discussing before your operation.

Should my metalwork be removed?

Only if it is causing symptoms, and usually not until the bone has fully healed. Removing metalwork that is prominent and painful is a small procedure and often works well, but it is not done routinely.

Does it help to see the surgeon who did the original operation?

Usually yes, as a first step — they know exactly what was done and what they found. If you are still worried after that conversation, an independent opinion is a reasonable next step.

Is there any point if I have already had several operations?

Yes. Feet that have had several operations are exactly where a careful, systematic reassessment helps most, because the picture has become complicated. The answer may be that no more surgery is advisable, which is still worth knowing.

Pain that carries on after foot or ankle surgery is worth investigating properly rather than waiting indefinitely. The aim of a second opinion is a clear explanation — what is causing the pain, what can realistically be changed, and what cannot.

Mr Matthew Welck is a Consultant Orthopaedic Foot & Ankle Surgeon at the Royal National Orthopaedic Hospital, Stanmore, and Honorary Associate Clinical Professor at UCL. His work includes revision and complex reconstructive foot and ankle surgery, and he has access to weight-bearing CT, MRI and keyhole surgery at the RNOH and at his private clinics. He welcomes second-opinion referrals from patients and doctors across North and Central London.

Please bring all previous scans, operation notes and clinic letters to your appointment — it makes the consultation much more useful.

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Study data above retrieved via PubMed.

This article is for general information and patient education only. It is not a substitute for a personal assessment, diagnosis or treatment by a qualified healthcare professional.

Written by: Matthew Welck | Consultant Orthopaedic Foot & Ankle Surgeon London — last updated 8 August 2026