How Long Does Pain Last After Ankle Surgery? A Complete Guide

In recent years, the rate at which patients underwent ankle fusion—just one common ankle surgery—increased 146%. Maybe, like these patients, you're opting for ankle surgery after more conservative treatments have failed. Or maybe you've broken your ankle so severely that only surgery can repair it. Either way, you need to know what to expect. How long does pain last after ankle surgery?

Most patients feel pain for 2 to 3 days following ankle surgery. From there, the pain gradually but noticeably decreases. By 6 weeks after surgery, the vast majority of patients are pain-free.

Why Might You Need Ankle Surgery?

Some patients undergo ankle surgery when conservative treatments for conditions, like arthritis, have failed. Others need ankle surgery for a severe fracture or torn ligaments or tendons. Finally, some patients experience chronic pain or instability following one or more ankle injuries. These patients may find relief from ankle surgery.

Most ankle surgeries are considered "elective." However, this doesn't necessarily mean that the surgery is optional. Rather, elective surgeries are simply those that can be scheduled in advance. Unlike urgent or emergency surgeries, the need is not life-threatening. Thus, elective surgeries need not be performed immediately. The need is nevertheless real.

What Are Some Common Ankle Surgeries?

The type of ankle surgery you need depends on the underlying condition or injury. Some of the most common surgeries repair fractures and torn ligaments. Others address chronic pain and instability. 

Open Reduction and Internal Fixation Surgery

If you've suffered a displaced ankle fracture, your doctor will need to set the bones back into place. Displaced fractures mean that the bone has not only broken. It has also moved out of place.

Setting, or reducing, the fracture ensures that the bone heals properly. Often it's possible to set the fracture using a closed reduction. During a closed reduction, your doctor manipulates the bones from the outside. While it doesn't involve an incision, this procedure can be very painful. However, your doctor will give you an anesthetic to block the pain.

In some cases, the doctor can't set a fracture using a closed reduction. These patients require an open reduction and internal fixation (ORIF) surgery. During this procedure, the doctor makes an incision and repositions the broken bones. He or she then uses surgical screws, plates, or wires to keep them in place.

Ankle Ligament Reconstruction Surgery

If you're suffering from chronic instability, you might benefit from ankle ligament reconstruction surgery. In this surgery, your doctor will tighten the ligaments that keep your ankle stable. The surgeon might achieve this tightening by restructuring the ligaments so that they overlap or span a shorter distance before attaching to the bone.

Ankle Replacement Surgery

Patients suffering from arthritis of the ankle may opt for an ankle replacement if conservative measures have failed. During ankle replacement surgery, your doctor will remove the damaged ends of the bones. He or she will then put an artificial joint—made of metal and plastic—in their place.

Ankle Fusion

Ankle fusion is an alternative to ankle replacement. Like ankle replacement, it can be very effective at relieving pain. However, its results tend to be longer-lasting. Patients also face fewer restrictions on their activities following ankle fusion. Thus, younger patients suffering from ankle arthritis often choose this option.

During ankle fusion, your doctor will attach two or more of your ankle bones together. Some procedures involve fixation using plates and screws. In other cases, bone grafts allow the two bones to grow together. 

Is It Normal to Have Pain After Ankle Surgery?

Yes. Studies show that the majority of patients experience pain after ankle surgery. In fact, ankle surgery ranks among the seven most painful surgical procedures.

How Much Pain Is Normal After Ankle Surgery?

For most patients, the pain immediately after ankle surgery is significant. A review of multiple studies found that, on a scale of zero to 10, most patients rated their pain above a five. 

This pain is generally independent of a patient's age or gender. The intensity of pain is likewise similar across patients suffering from acute and chronic conditions.

Still, some factors are associated with increased pain. These include a higher body mass index (BMI) and a longer duration of surgery. 

Patients' pre-surgical experiences and expectations also consistently predict post-operative pain levels. Patients who experience greater pain before surgery tend to experience greater pain after surgery. Furthermore, patients who anticipate having significant pain after surgery report high levels of post-operative pain. 

Hearing these statistics as you plan for ankle surgery can be frightening. However, it's important to keep in mind that your doctor will help you manage your pain. It's also important to keep in mind that the pain is temporary.

You might wonder then, "How long after ankle surgery will it stop hurting?" Again, studies provide a definitive and, in this case, more encouraging answer.

How Long Does Pain Last After Ankle Surgery?

Studies find that pain peaks by the third day after ankle surgery. After this initial period, the pain gradually but noticeably diminishes. The majority of patients were pain-free by six weeks after surgery.

How Can I Manage Pain Following Ankle Surgery?

Your doctor will help you manage your post-operative discomfort. These efforts will involve medications and non-medication interventions. 

Medications

Two main types of drugs figure in post-operative pain management: opiate and non-opiate medications.

Opiates, like tramadol and oxycodone, can be very effective at relieving pain. However, they are highly addictive and should be used with great caution. Your doctor will advise you to use them only when absolutely necessary during the initial period of intense pain. Failing to follow these instructions can cause serious and even life-threatening problems. It can also lead to increased pain.

Non-opiate pain relievers include over-the-counter and prescription ibuprofen and acetaminophen. You can use these medications more frequently. You can also expect to take them at least until your first follow-up appointment.

In severe cases, your doctor might also insert a catheter to supply a regional anesthetic to the surgery site.

Non-Medication Interventions

Non-medication interventions focus on the "RICE" method. RICE stands for Rest, Ice, Compression, and Elevation. 

Following surgery, your doctor will advise you to rest both your ankle and your body after surgery. In fact, your body needs rest to heal. This means that you shouldn't plan any activities for the first few days or even a week after surgery. You should also get plenty of sleep.

Resting your ankle also means following your doctor's instructions regarding weight-bearing. In most cases, your doctor will supply you with crutches and instruct you to avoid bearing weight on your surgery foot for some time. Follow these instructions carefully.

When you are resting, it's also important to keep your foot elevated at heart level. For the first two to three days, you should maintain this elevation for at least 95% of the day. If your foot must be down, make sure that it remains so for no more than 10 minutes at a time. Keeping your foot elevated reduces swelling, which, in turn, reduces pain.

Finally, you'll need to adhere to a consistent icing regimen, especially for the first few days. Like elevation, ice helps to reduce inflammation and swelling and, thus, pain. Icing your ankle for 20 minutes every hour produces the greatest benefits.

Since the RICE method is so important to your recovery, it's natural to have more questions. You might wonder about the best position for sleeping. You might also wonder how long you need to maintain these measures.

Can You Sleep On Your Side After Ankle Surgery?

Unless your doctor recommends otherwise, you can sleep in any position that's comfortable as long as you keep your leg elevated. 

Most patients find it easiest to sleep on their backs with two or three pillows beneath their injured leg. 

Still, you might find this position uncomfortable, or you may simply prefer sleeping on your side. Fortunately, you can sleep safely on your non-surgery side.

Again, you'll need to elevate your affected ankle. A few pillows—or even a body pillow—between your legs can accomplish this purpose. Make sure that the pillows extend from your knee to your foot. Also make sure that your foot is above heart level.

How Long Should You Keep Your Leg Elevated After Ankle Surgery?

You need to maximize the time your foot is elevated for at least the first 72 hours after surgery. During this time, you'll need to get up to go to the bathroom or to move from your bed to the couch, for example. At all other times, though, your foot should remain elevated.

After the first three days, you can gradually increase your mobility according to your doctor's guidance. If your doctor has prescribed crutches, use them any time you need to move. Also continue to keep your foot elevated whenever you are seated or lying down. Maintain this elevation for at least the next two or three weeks.

Recovering from Ankle Surgery: What Else Can You Expect?

As you recover from ankle surgery, pain is one of your most immediate concerns. Fortunately, this pain diminishes significantly after the initial post-operative period. However, full recovery—and lasting pain-relief—require additional measures, like physical therapy.

How Long Is Physical Therapy After Ankle Surgery?

In most cases, you can expect to work with a physical therapist for at least six to eight weeks after surgery. During your therapy appointments, you'll work with exercise equipment and weights. Your therapist might also use ultrasound, electric stimulation (e-stim) therapy, heat, and ice. These efforts aim to reduce inflammation and increase mobility.

The work you and your therapist do at your appointments is important. Equally important, though, is the work you do at home. During your therapy sessions, you'll also learn exercises you can—and must—do at home. These home exercises strengthen your injured ankle and the surrounding muscles. 

Adhering to your at-home therapy program is essential to your long-term recovery.

Can You Fully Recover from a Broken Ankle or Other Injury Requiring Surgery?

Yes! Recovering fully from an ankle fracture or another injury requiring surgery can take several months. During this time, your bones, muscles, ligaments, and tendons must heal. Once your injured tissues are strong, you must also regain strength and mobility in the surrounding tissues.

Of course, every patient, every injury, and every surgical procedure is different. Factors like age and overall health and fitness affect recovery time. Younger patients typically experience quicker recovery times than older patients. Likewise, the severity of the injury and the complexity of the surgery play a role.

At any age and with any surgery, however, recovery is possible. Following your doctor's advice, getting adequate rest, and adhering to your physical therapy program promote this recovery.

Are There Any Other Complications Associated with Ankle Surgery?

Ankle surgery is highly effective and safe. However, every surgery involves some risk of complications. These include:

• Infection
• Bleeding
• Blood clots
• Nerve damage

Certain medications and underlying conditions can increase the risk of these complications. For example, you might be taking blood thinners to reduce your risk of stroke. If so, you may be at higher risk for bleeding during surgery. Your doctor can advise you of these risks and take steps to lessen them.

Nerve damage is another complication patients experience following ankle surgery. In fact, studies find that it is the most common complication associated with foot and ankle surgery. If you experience burning, tingling, or numbness after surgery, you may have suffered a cutaneous nerve injury. So, you might wonder, "How long does it take for nerves to heal after ankle surgery?"

When a nerve is injured, it needs to regrow and repair its protective covering before healing fully. Nerves grow about an inch each month, and the entire process takes about six months for most patients.

Stepping Out on the Right Foot After Ankle Surgery

Ankle surgeries are common but painful procedures. It's natural to wonder, then, "How long does pain last after ankle surgery?" In fact, most patients are pain-free by six months after surgery.

For most patients, this temporary post-operative discomfort is worth the decreased pain and increased mobility they enjoy in the long term. In the long term, ankle surgeries are highly effective at relieving pain and improving quality of life.

Following your doctor's advice and completing your at-home therapy program are steps you can take to promote your recovery. As you take these steps and get back to your active lifestyle, count on PowerRebound's blogs for the best advice.