Forty five studies analyzing analgesic interventions after foot and ankle surgery with reported pain scores and/or postoperative analgesic consumption were included in this systematic review. The purpose of the study was to assess the management of pain after elective foot and ankle surgery in an updated review. Regional analgesia, acetaminophen, NSAIDs, cyclooxygenase-2 selective inhibitors, a single intraoperative dose of parenteral dexamethasone, and opioids all demonstrated efficacy in pain relief relative to placebo. Popliteal sciatic nerve block provided a longer duration of analgesia when compared to ankle block. Future study is required to provide high-quality evidence regarding the analgesic benefits of different postoperative analgesia interventions in foot and ankle surgery.