Pain management in foot and ankle surgery: a multidisciplinary approach

Foot surgery is the 10th most frequent day-hospital procedure, and the 39th most common in-hospital surgical procedure in Italy. Despite significant advancements in surgical and anesthetic techniques, foot and ankle post-operative pain remains intense and prolonged. Post-operative pain could extend hospital stays, delay a complete functional recovery and increase the risk of chronic post-operative pain. Above all, postponing the resumption of weight-bearing activities could undermine the very effectiveness of the procedure. Effectively managing post-operative pain is a multifaceted challenge and requires collaborative efforts among various specialists, along with surgeons, anesthesiologists, pharmacologists, nutritionists, and general practitioners. This narrative review summarizes current literature on pain management in foot and ankle surgeries and provides expert opinions drawing from the guidelines established by the Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI), the American Pain Society (APS), and the European Society of Regional Anaesthesia (ESRA) Procedure-specific postoperative pain management (PROSPECT), an approach inspired by the Enhanced Recovery After Surgery (ERAS) paradigm. In addition to suggesting a pharmacological framework for managing peri-and postoperative pain, this expert group offers recommendations about the patient at-home nutrition, interactions between the healthcare team and patients/caregivers, as well as exploring perspectives to improve patient care in the territory.