Painful hardware of the foot and ankle is common following ORIF. The bones of the foot and ankle have little subcutaneous tissue and skin coverage that often causes sensitivity over the underlying hardware. Patients often complain of tenderness as well as heightened pain during activities. Screw displacement with tenting of the skin that is visible on radiograph is an obvious indication for removal of hardware.

Nondisplaced painful hardware is a challenging problem to address. While removal of hardware is a common procedure that is performed following foot and ankle surgery, no widely accepted indications exist for doing so. According to a study published in the Journal of Orthopaedic Trauma, 31% of patients with a history of ORIF for an unstable ankle fracture went on to have symptomatic hardware.1 The average time for removal of hardware postoperatively was 37 weeks, and only 50% of patients who had hardware removed reported an improvement in pain. Other studies have reported relief of pain in up to 65% of patients after removal of hardware from the ankle.2 Removal of hardware is usually considered well after bony union or around 8 to 12 months postoperatively if chronic pain is present.

Dagan Cloutier, MPAS, PA-C, practices in a multispecialty orthopedic group in the southern New Hampshire region and is editor-in-chief of the Journal of Orthopedics for Physician Assistants (JOPA).


  1. Brown OL, Dirschl DR, Obremskey WT. Incidence of hardware-related pain and its effect on functional outcomes after open reduction and internal fixation of ankle fractures. J Orthop Trauma. 2001;15(4):271-274.
  2. Williams AA, Witten DM, Duester R, Chou LB. The benefits of implant removal from the foot and ankle.J Bone Joint Surg Am. 2012;94(14):1316-1320.
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