General Complications of Foot and Ankle Surgery

What does this document explain?

Surgery is not without risk. Fortunately, the risk of complications occurring in foot and ankle surgery are low. However, if you are the one who ends up suffering from any of them then this may result in significant problems with your ability to function on a day to day basis, enjoy your recreational activities and even perform your job. This may last for a long period or may even become permanent. You may require further surgery or other treatments to try and alleviate the problem.

Whilst there are certain complications that are specific to a procedure, there are some common complications that are seen in all foot and ankle surgery. This document explains some of these that occur frequently or are rare but can cause significant morbidity and as such you must understand them prior to consenting for surgery.

This document should therefore be read in conjunction with the document specific to your surgery.

What are the general complications of foot and ankle surgery?


Infection can occur after any surgery. Bactria can enter the surgical site from the skin and flora of the patient or the operating theatre personnel. The operating theatre is a highly sterile environment and routine protocols, and practices are in place to reduce the risk of bacterial contamination. In certain operations where metal implants are inserted, antibiotics are also given routinely to help with prevention of infection. Most orthopaedic theatres operate under positive airflow systems which continuously clears the air around the operative field.

Fortunately, infection rates are low and less than 1-2%. Of those infections most are considered superficial. In a superficial infection there would be redness, pain and discharge from the surgical incision which would then be treated with oral antibiotics. You may also feel unwell or have a temperature. Occasionally intravenous antibiotic treatment in hospital may be required. Superficial infections can be treated without surgery however if the infection is in deeper tissues then surgery may be needed.

Deep Infections can be difficult to manage especially if the metal work or the underlying bone is involved. Patients often require multiple visits to the operating theatre to remove all infected tissue and hardware. Plastic surgery to replace the infected tissue by skin graft or flaps are sometimes necessary and in rare circumstances the limb maybe threatened, and an amputation may be necessary. This is an exceedingly rare event.


It is very uncommon for serious bleeding to occur following foot and ankle surgery; blood transfusions or shock are exceedingly rare. However small local bleeding around the wounds can occur this may result in skin healing problems and sometimes may necessitate further surgery to evacuate any blood clots or revise the surgical incision. Use of blood thinning medications can exacerbate this problem.

Nerve Injury or Numbness

There are several small superficial nerves that supply the foot. Nearly all of these are sensory only meaning the provide sensation to parts of your foot. These also branch out to even smaller nerves supplying sensation to a corresponding smaller area of the skin. These can be as small or only slightly larger than a strand of human hair. During foot and ankle surgery the location of these nerves is known to the surgeon and care is taken to protect them, as a result rates of injury are low.

However, the nerves or the smaller branches do at times get stretched or cut. This results in numbness or abnormal sensation in the patch of skin supplied by the nerve. Often this can resolve in time but occasionally it can persist indefinitely. Occasionally the cut end of the nerve can attempt to regrow forming a painful and sensitive area known as a neuroma. If this occurs, then you may require further surgery to remove the neuroma or occasionally this may be treated with injections or with wound massage therapy.

Very rarely the nerves supplying the muscles in the foot may be involved with injury causing atrophy of these muscles which may be apparent as an asymmetry between your two feet and very rarely still may result in claw deformities of the toes.

Complex regional pain syndrome (CRPS)

This is a condition that can occasionally cause significant pain after what is reasonably minor surgery with apparently good results. The exact underlying cause is not fully understood however it may be related to a dysfunction of the peripheral or central nervous systems. Those affected will have pain which is normally out of proportion to the initial injury. There may be associated colour change in the limb as well as abnormal sweating on the feeling of hot and cold. The pain maybe present in the entire lower limb and can occasionally radiate all the way up to the hip. Other symptoms may include continuous and throbbing pain; burning and stinging; swelling; hair and nail changes; osteoporosis; joint stiffness and reduced mobility.

The key to managing this condition is to identify the problem early and commence treatment with reassurance and early active range of motion with intensive physiotherapy as well as pain management strategies and pain killers.


Surgery on the foot or the ankle is often followed by a period of immobilisation. This may be in a boot or in a plaster cast all may merely mean a reduction in the normal use of the joints of the foot. As a result, there may be some corresponding stiffness. Most stiffness in the midfoot joints is not always apparent to the patience stiffness in the big toe or the ankle joint can cause significant or restriction. For this reason, prolonged immobilisation or use of boots for an extended period is avoided and attention is given to mobilisation and physiotherapy. If these measures fail to manage the situation then occasionally a manipulation under anaesthesia or surgery maybe indicated.


Surgery can provoke the formation of a blood clot in the deep veins of the lower leg. This is known as a deep vein thrombosis. the risk of this occurring is dependent on many factors and a specific leaflet has been written to deal with this and I encourage that you read that as well as the current leaflet. Rarely the blood clots can break off and end up in the lungs where they can cause shortness of breath and significant complications. This is known as a pulmonary embolus.

Persisting pain

Very rarely unfortunately even despite a seemingly successful operation and in the absence of any complications such as the ones listed in this leaflet some patients may complain of persisting pain in the site of the surgery or in an entirely new area in the foot and ankle. Whilst pain without an obvious cause is extremely rare it can on occasions be a source of extreme frustration for all involved.