For polio survivors, the decision to proceed with surgery is usually a significant turning point driven by a cascade of interrelated problems. While pain is a major factor, it's often the specific type of pain—a deep, debilitating ache from joints being forced into misalignment—that becomes unbearable. However, the most common surgical trigger is often a progressive, uncorrectable deformity, such as a severely dropped foot (equinus) or a rigid, high-arched foot (cavovarus). This deformity leads directly to the other critical triggers: it causes functional loss by creating extreme instability and a high risk of tripping and falling, and it can make it mechanically impossible to fit or use an ankle-foot orthosis (AFO) effectively. Therefore, the decision is typically made when the person reaches a point where the deformity and instability prevent safe ambulation or standing, even with bracing, and the pain can no longer be managed conservatively, making surgery the only option to restore a baseline of function and safety.