A Systematic Review of Complications Following Elective Foot and Ankle Surgery.

Introduction

Complications following elective foot and ankle surgery are a significant source of morbidity and may impair recovery. Evidence is often procedure specific, limiting a broader understanding. This review aimed to synthesize complication profiles, risk factors, and mitigation strategies across elective procedures.

Methods

PubMed, Scopus, and CINAHL were searched for studies published between 1 January 2020 and 30 June 2025. Eligible studies included adults undergoing elective foot and ankle surgery and reporting postoperative complications. Data were extracted on complication type, incidence, and risk factors, and synthesized narratively due to heterogeneity.

Results

Nine studies (n = 20,455) were included. Complication rates varied: infection (0.3%-12.5%), wound healing problems (0.5%-10.0%), nonunion (0.8%-18.7%), hardware removal (3.8%-15.5%), nerve injury (0.2%-10.0%), pain or stiffness (0.8%-18.7%), and systemic complications (3.6%-7.4%). Consistent risk factors included diabetes, obesity, smoking, and peripheral vascular disease. Higher complication rates were associated with revision surgery, prolonged operative time, and multisegment reconstruction.

Conclusion

Complications after elective foot and ankle surgery are common and multifactorial, with consistent risk patterns across procedures. These findings support improved risk stratification, targeted preoperative optimization, and structured postoperative care.

Keywords

elective ankle surgery, elective foot surgery, nonunion, postoperative complications, risk factors, surgical site infection, systematic review