Surgery for leg pain

Is surgery right for leg pain?

Leg pain is a symptom, not a diagnosis. Surgery is not the starting point for most people. The right approach depends on the cause, such as blood flow problems, blood clots, nerve irritation, bone stress injuries, or compartment syndromes. Many of these improve with medicines, exercise based rehab, and lifestyle changes, without an operation. ^{1 2 4 11 19}

Doctors are more likely to talk about surgery when:

• There is a serious blood flow problem, such as acute limb ischaemia, where the leg suddenly becomes very painful, pale or bluish, and weak. This is limb threatening and often needs urgent procedures to remove or bypass a clot. ^{2 5}
• You have peripheral artery disease and claudication that still limits your walking a lot after supervised exercise and optimal medical treatment. ^{2 15 16}
• You have chronic exertional compartment syndrome with clear, repeatable symptoms and pressure testing that confirms the diagnosis, and non surgical care has not helped. ^{14 21 22}
• You have a high risk bone stress injury or a stress fracture that is not healing with protection and rehab. ^{11 12 19 20}
• There is a clear structural nerve or spine problem causing significant weakness, loss of function, or pain that does not improve with good conservative care, such as severe nerve-related leg pain with nerve root compression.⁴

The decision to have surgery is always individual. It is based on your diagnosis, overall health, risks, and what matters most to you, not just the scan or test result. Shared decision making with your vascular specialist, surgeon, or spine team is key. ^{2 4 5}

Common surgical options for leg pain

Because leg pain has many causes, the surgeries used can be quite different. Here are some of the more common types your team might discuss, depending on the problem.

• Revascularisation procedures for peripheral artery disease. These aim to improve blood flow when arteries are narrowed or blocked. They may include a minimally invasive procedure to open blocked arteries (angioplasty) and stenting through a catheter, or bypass surgery that creates a new route around the blockage using a vein or graft. These are usually considered for limb threatening ischaemia or claudication that still severely limits life after supervised exercise and best medical therapy.^{2 3 5 15 16}
• Urgent surgery for acute limb ischaemia or severe clot problems. In acute limb ischaemia, surgery or catheter procedures can remove or break up a clot to restore blood flow. ^{2 5} In selected cases of vein clots, removal strategies may be considered in specialist centres, alongside anticoagulation. ^{1 9 10}
• Fasciotomy for compartment syndrome. When there is high pressure inside the leg that does not respond to conservative care, surgeons may cut the tight fascia around the muscles (fasciotomy) to relieve pressure. This can be limb saving in acute cases and can reduce exertional pain in chronic cases, although outcomes vary. ^{14 21 22}
• Fixation of high risk or non healing stress fractures. Some stress injuries locations have a higher chance of complete fracture or non-healing. In these cases, fixation surgery with screws or plates, sometimes with bone grafting, may be recommended to stabilise the bone and support healing.^{11 12 19 20}
• Nerve decompression and spine surgery in selected cases. Focal nerve entrapments may be treated with decompression surgery if symptoms are severe or do not respond to unloading and rehab^.17 Spine surgery may be considered for severe nerve-related leg pain or progressive weakness due to nerve root compression that has not improved with non surgical care.⁴

Your team will suggest options only after identifying the main driver of your leg pain and weighing the potential benefits and risks for you.

What to expect during recovery

Recovery after surgery for leg pain depends on the type of operation and your overall health. Vascular surgeries, fasciotomies, fracture fixation, and spine or nerve procedures all have different timelines, but some themes are similar.^{1 2 4 11 14 19 22}

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

• You are usually in hospital for monitoring, especially after vascular procedures, major fracture surgery, or fasciotomy. Staff will watch blood flow, wounds, pain levels, and signs of complications. ^{2 5 22}
• Pain, swelling, and bruising are common. You will receive a plan for pain relief, wound care, leg elevation, and early gentle movement where safe.
• Blood clot prevention, such as anticoagulant medicine, stockings, or early walking, is often used after major procedures to reduce the risk of venous thromboembolism (vein clots). ^{1 8 10}

Early recovery (first several weeks)

• For revascularisation, you usually start walking early, with goals to gradually extend your walking time while your wounds heal and your cardiovascular risk factors are treated. Supervised exercise or structured walking programs remain important even after procedures. ^{2 15 16}
• After fasciotomy, wounds may be left partly open at first, then closed later or covered with skin grafts. You and your team will work on gentle range of motion, swelling control, and gradual weight bearing as allowed. ^{14 22}
• After stress fracture fixation, you may need a period of non weight bearing or protected weight bearing in a boot or brace. Pain guided transitions and follow up imaging often guide when it is safe to increase load. ^{11 12 19 20}
• After nerve or spine surgery, early mobility, posture education, and modified activities are used to protect healing while avoiding long bed rest.⁴

Rebuilding phase (weeks to months)

• Physical therapy usually focuses on strength of the calf, hip, and core muscles, gait training, and balance work to restore confidence in the leg. ^{4 11 19 22}
• For arterial disease, structured walking remains a cornerstone, even after revascularisation, to maintain gains and support heart and vessel health.^{2 15 16}
• For stress fractures, you progress from low impact exercise to gradual running or sport specific drills, using symptoms and sometimes imaging as guides. ^{11 19 20}

Long term recovery and possible risks

Depending on the procedure and your starting health, it may take many months to feel your best again. Some people notice lasting numbness, mild aching, or reduced endurance. There are also potential risks, such as:

• Infection, bleeding, or wound healing problems
• Blood clots in the leg or lungs
• Ongoing pain, stiffness, or weakness
• Vessels narrowing or blocking again after vascular procedures
• Non-healing or re-fracture after stress fracture surgery
• Incomplete relief or recurrence of symptoms after fasciotomy or nerve or spine surgery ^{1 2 4 11 14 19 22}

Your team can help you understand your specific risks and create a plan that includes rehabilitation, medication, and lifestyle changes to support long term success.

Can surgery be avoided?

In many situations, yes. For a large number of people with leg pain, the best first step is to treat the underlying problem with non surgical care and give the body time to respond.

Examples include:

• For leg pain caused by poor blood flow, supervised exercise and structured walking programs can greatly improve how far people can walk and reduce leg pain. Medications and managing risk factors also help. For most people with stable symptoms, guidelines recommend trying these options before procedures to improve blood flow. ^{2 15 16}
• Deep vein thrombosis. The main treatment is anticoagulation, not surgery. Early blood thinning reduces the risk of pulmonary embolism (lung clots) and future clots. Surgery or catheter procedures are reserved for special cases, such as threatened limb in expert centres.^{1 8 9 10}
• Sciatica and other nerve-related leg pain. Many people recover over weeks to months with education, staying active, exercise based and psychologically informed rehab, and time. Guidelines advise against routine early MRI, strong medicines, or opioids for most people, and reserve injections and surgery for those with more severe or persistent problems. ⁴
• Bone stress injuries and medial tibial stress syndrome. Most bone stress injuries heal with load reduction, attention to nutrition and energy availability, and a structured return to running and impact. Only high risk sites or non healing cases typically need surgery. ^{11 12 19 20}
• Chronic exertional compartment syndrome. Some people improve with gait retraining, activity modification, and strength work, although the evidence here is still limited.^{14 21}

If you are unsure whether surgery is avoidable in your case, a good starting point is a clear diagnosis, a conversation about red flags, and a committed trial of appropriate conservative care whenever it is safe to do so.

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 blood flow related leg pain stress that supervised exercise and strong risk factor control are the first treatments to try. Procedures to improve blood flow are mainly used when the limb is at risk or when leg pain stays disabling despite the best non surgical care.2 15 16 Together, this highlights the importance of matching the level of treatment to how severe the problem is, not just the presence of leg pain. ^{2 15 16}