Surgery for ankle pain

Is surgery right for ankle pain?

Surgery for ankle pain is not automatic. Most people start with non-surgical care like exercise, bracing, and activity changes, and many never need an operation^{1 7 13}.

Doctors usually think about surgery when:

• Pain or swelling stays strong even after a full course of good rehabilitation, footwear changes, and medications where appropriate^{1 7 13}.
• The ankle feels like it is “giving way” because the ligaments are truly loose, and this has not improved with balance and strength training¹.
• There is a clear problem inside the joint, like a large cartilage or bone injury (osteochondral lesion) that keeps causing locking, catching, or swelling¹⁶.
• X-rays and scans show severe ankle arthritis with major stiffness, deformity, or difficulty walking day to day^{7 17}.

The choice to have surgery is always individual. It depends on your goals (for example, walking your dog versus playing high-level sport), your overall health, and how well non-surgical treatments have worked. Shared decision-making with your surgeon and care team is key so you understand the likely benefits, risks, and other options^{7 17}.

Common surgical options for ankle pain

Here are some of the more common ankle surgeries your doctor might discuss. Not everyone with ankle pain will need any of these.

• Lateral ligament repair or reconstruction: This surgery tightens or rebuilds the outer ankle ligaments that were stretched or torn with repeated sprains. It is usually considered when people still have true mechanical instability and frequent “giving way” after several months of targeted rehab^{1 13}.
• Syndesmosis (high ankle) stabilization: If the ligaments between the shin bones above the ankle are badly injured, screws or a flexible “tightrope” device may be used to hold the bones in place while they heal. This is more common after high-energy twists or fractures and is used when the joint is clearly unstable¹.
• Tendon repair or reconstruction: Foot and ankle tendons can tear or become badly damaged over time. Surgery may clean out scar tissue, repair a tear, or transfer a nearby tendon to share the load (moving one tendon to another bone to help movement)^{2 15}.
• Cartilage and bone procedures for osteochondral lesions: If there is a focused area of damaged cartilage and bone in the ankle (often from an old injury), the surgeon may perform arthroscopy (keyhole surgery) to clean the area, drill tiny holes to stimulate healing, fix loose fragments with screws, or place grafts or cell-based treatments depending on lesion size and depth¹⁶.
• Ankle fusion (arthrodesis): In severe ankle arthritis, the surgeon may fuse the bones of the ankle so they grow into one solid piece. This usually relieves pain by stopping the painful motion, but it limits ankle movement and shifts load to nearby joints. It is often chosen for people who do heavy labor or have certain deformities^{7 17}.
• Total ankle replacement (ankle arthroplasty): In some cases of end-stage arthritis, surgeons can replace the worn joint surfaces with metal and plastic components, similar to a knee or hip replacement. This aims to reduce pain while preserving more movement than a fusion, and it is usually done in specialized centers^{7 17}.

Your surgeon will match the type of surgery to the exact structure that is causing your pain, your activity level, and your long-term goals.

What to expect during recovery

Recovery from ankle surgery is a journey, not a single moment. It usually happens in phases, and the timeline depends on the type of surgery, your health, and how strong and mobile the ankle was before surgery^{1 7 14 16 17}.

Right after surgery (days to the first couple of weeks)

• Your ankle is often in a splint or boot to protect the repair.
• Weight-bearing can range from none at all to partial or full, depending on the procedure. Your surgical team will give clear instructions^{1 7 16}.
• Swelling, pain, and stiffness are common. You usually receive a plan for pain relief, elevation, and gentle movement of nearby joints (hip, knee, toes).

Early recovery (first several weeks)

• You may move from a splint to a boot, sometimes with crutches or a walker.
• Physical therapy often starts with gentle range-of-motion exercises, swelling control, and basic strength in the hip and knee^{1 7 14}.
• Your team will usually watch for warning signs such as redness, fever, or increasing pain that could suggest infection or blood clot^{7 12}.

Rebuilding phase (several weeks to a few months)

• As healing allows, you typically work on calf and ankle strength, balance, and walking pattern.
• For cartilage or fusion surgeries, weight-bearing is sometimes increased more slowly so the bone and joint can heal^{16 17}.
• People with ligament reconstructions may begin more advanced balance exercises and, later on, light jogging and change-of-direction drills if sport is a goal^{1 14}.

Long-term recovery (many months)

• It can take many months for swelling to calm down, and for your ankle to feel like it “belongs” to you again. This is normal and does not always mean something is wrong^{7 14 17}.
• Some people notice lasting stiffness or mild aches with weather or heavy use, even after a successful surgery^{7 16 17}.

Possible risks and complications

Every surgery has risks. For ankle surgery, these can include:

• Infection or problems with wound healing
• Blood clots in the leg
• Damage or irritation to nerves or blood vessels
• Stiffness, weakness, or ongoing pain
• Failure of a fusion to fully heal, or loosening or wear of a replacement joint
• Need for further surgery if symptoms persist or new problems develop^{7 16 17}

Knowing what to expect and having a clear plan with your care team can make recovery feel less scary and more manageable.

Can surgery be avoided?

In many cases, yes. A large number of people with ankle pain improve with a thoughtful non-surgical plan that targets the real problem, not just the pain^{1 7 13}.

Non-surgical options often include:

• Exercise-based rehabilitation for strength, balance, and ankle control, especially after sprains and in chronic ankle instability. This helps reduce pain and lowers the chance of repeat sprains^{1 13}.
• Bracing or taping during higher-risk activities to support loose ligaments while you rebuild strength^{1 18}.
• Footwear changes and orthoses to support flat feet, high arches, or tendon problems, which can take stress off the ankle joint^{7 15}.
• Weight management and activity pacing to reduce load on the ankle in joint wear and tendon problems^{2 7}.
• Short-term medications or injections to calm flares while you stay active within tolerable limits^{7 11}.

There is also growing evidence that digital physical therapy programs can help people with chronic musculoskeletal pain. In randomized trials, fully remote exercise-based digital care for chronic shoulder and low back pain achieved improvements in pain and function that were similar to conventional in-person physical therapy, with high adherence and satisfaction^{19 20}. This supports digital care as a safe, effective way to deliver conservative treatment for many conditions when used appropriately.

If you are wondering whether surgery can be avoided, a good first step is a structured course of physical therapy that focuses on strength, balance, and confidence in your ankle, alongside the lifestyle and footwear changes that fit your life. Together with your clinician, you can decide on surgery only if you truly need it.

How Sword can support you before and after surgery

Physical therapy can play an important role in preparing for surgery, supporting recovery, and, in some cases, helping people manage symptoms without surgery. Sword offers physical therapy programs designed to support you at different points along that journey.

Sword supports recovery before and after surgery, with care designed to fit into your life. You receive high-quality physical therapy at home, guided by licensed clinicians and supported by smart technology.

• Care that adapts as your body and recovery needs change
• Licensed physical therapists guiding your care at every stage
• Non-invasive, evidence-based physical therapy programs

Support for preparation, recovery, and long-term movement health

Clinical insight

Guidelines for ankle sprains and ankle arthritis highlight that surgery is usually reserved for specific situations, such as persistent mechanical instability or end-stage joint damage, after a strong trial of non-surgical care^{1 7 17}.