Objective The purpose of this study was to study postoperative pain in ankle joints and explore the relationship between perioperative factors and postoperative pain. Methods 49 patients underwent surgical treatment for ankle osteoarthritis were followed up to assess the patient's duration, severity, preoperative pain type, psychological factors, opioid consumption, and type of surgery. Acute postoperative pain in the first 10 days after surgery was assessed by numerical scoring for pain assessment, and univariate factors were analyzed to determine factors affecting acute and chronic pain. Results 87% of patients had symptoms of chronic pain before operation, 34% of patients had higher intensity pain after operation, 44% of them reported chronic pain at 18 months. The patients with high acute pain had higher consumption of opioids (50% vs. 194%, P=004), higher incidence of preoperative neuropathic pain (688% vs. 323%, P=002), higher score in pain scale investigation (515 vs. 34, P=001), higher score of psychological distress (8 vs. 3, P=0002). Patients with chronic pain had higher pain scale score (42∶33, P=004), higher psychological pain score (6∶4, P=004), and higher preoperative pain intensity (8∶6, P=0008). There was no association between the type of ankle surgery and pain. Conclusion Regardless of the type of surgical procedure, patients with more psychological burden and severe preoperative pain are more likely to develop acute and chronic pain after ankle surgery.