Ankle arthrofibrosis or scar tissue in the ankle is common after injury, surgery, or prolonged immobilisation. Often, patients experience general ankle pain and stiffness. What is ankle arthrofibrosis, and how can you manage it?
What is ankle arthrofibrosis?
We think of ankle arthrofibrosis as pain and reduced ankle motion due to scar tissue.
Common causes of excessive scar tissue in the ankle include:
- Severe ankle sprains
- Ankle surgery
- Infection
- Prolonged immobilisation in a cast
- Medical conditions such as haemophilia
Generally, scar tissue in the ankle develops after inflammation in the ankle joint. Excessive inflammation leads to an increase in scar tissue formation. Recent studies suggest some people are prone to developing excessive scar tissue after inflammation.
How to diagnose scar tissue in the ankle
Ususally, scar tissue presents as ankle pain, swelling, stiffness and reduced movement. People with scar tissue often struggle to go up slopes or stairs.
When examining your ankle, your doctor will watch you walk. Severe restriction in movement can lead to limping. When palpating your ankle, we often find thickening of the tissue in the ankle joint and discomfort or pain under pressure.
It is essential to obtain imaging to exclude other causes of pain and reduced ankle movement, such as ankle arthritis, anterior ankle impingement, cartilage injuries or loose bodies. Generally, we use weight-bearing X-rays, ultrasound and MRI scans to get more information about the causes. Ultrasound will often show capsule thickening and scar tissue formation.
Ankle arthrofibrosis treatment
Generally, once the diagnosis of ankle arthrofibrosis is made, we start with simple treatments. Physiotherapy helps improve range of motion, balance, and ankle strength. Your therapist will stretch and mobilise your stiff joint. Active stretching is also essential to improve mobility. Ankle balancing and strengthening exercises will also help.
In some cases of pain and swelling, we suggest trying medications such as ibuprofen.
Injections for ankle arthrofibrosis
Injections into the ankle joint may also be used to settle arthrofibrosis. Generally, we use cortisone injections to help break down scar tissue. Cortisone is a powerful anti-inflammatory drug that reduces inflammation and scar tissue. Usually, we use ultrasound guidance to direct cortisone directly into the scar tissue to improve its effectiveness.
Other injectables, such as hyaluronic acid and PRP, are generally less effective at breaking down scar tissue. However, we would use these injectables if there is a cartilage injury or ankle arthritis.
Ankle arthroscopy
In general, we suggest surgery if simple measures fail.
Ankle arthroscopy, or keyhole surgery, removes scar tissue and improves ankle mobility. Depending on the location of the scar tissue, keyhole surgery can be performed at the front or back of the ankle. However, evidence for the effectiveness of keyhole surgery is mixed and limited to a few studies. One review of arthroscopy for arthrofibrosis found limited evidence and was cautious in recommending surgery.
Open excision is also an option, although studies suggest no difference in outcomes between open and keyhole procedures.
Final word from Sportdoctorlondon regarding ankle arthrofibrosis
Ankle arthrofibrosis causes stiffness, limited mobility and pain in the ankle. You should see a doctor who is experienced in making the correct diagnosis and suggesting the proper treatment.
Related conditions:
65 year old male, . retired in the Philippines. after many years of ice hockey, ( non professional) my arthritic ankles, especially the right, have developed extensive ‘arthrofibrosis” . yes, Chronic. 15 years+ in development. Due to a lack of podiatrists in my area of residence, I am looking for suggestive treatment options and directions to regain my mobility9-walking with less pain). I am getting good massage, stretching, icing, and light exercising regularly. Maybe too much ! Please suggest some directions I can go to turn this corner and improve my walking mobility. edample 1, do you have online consultation ?
Hi Lawrence, you should see a physiotherapist and podiatrist to help you with your ankle strength and mobility. I suggest focused ankle exercise therapy. Other options include Durolane or PRP injections to help with rehab.
https://sportdoctorlondon.com/durolane-injection/
https://sportdoctorlondon.com/ankle-injection/
LM
Hi
Long standing ankle pain sufferer. Compound tib and fib over 40 years ago with 2 ankle (effusion?) fractures that went undiagnosed at the time.
Approximately 12 bouts of surgical intervention removing osteophytes that consistently grew back.
Took the step of an ankle replacement two years ago.
Recovery looked promising early days, however scar tissue inhibiting motion and is quite uncomfortable. Tried hydrodilitation but could only receive 11mms of fluid as the joint was too tight.
So – still suffering from tightness, and consistent pain. I have previously had adhesions removed,
Any ideas?
Thanks
Andrew
Dear Andrew,
Thank you for reaching out, and I am sorry to hear about the considerable journey you have been through — a compound tibial and fibular fracture over 40 years ago, multiple surgical interventions for recurrent osteophyte formation, and now persistent pain and stiffness following your ankle replacement. That is a long and difficult road, and I can understand why you are still searching for answers.
I want to be as helpful as I can, but I also need to be honest with you: your situation places you in a genuinely difficult predicament from an injection standpoint. With a total ankle replacement in situ, any injection into or around the joint carries a significantly elevated risk of infection compared to a native joint. Periprosthetic joint infection is a serious and potentially limb-threatening complication, and for that reason any injection — whether corticosteroid, hyaluronic acid, or indeed further hydrodilatation — would need to be carefully considered and coordinated directly with your orthopaedic surgeon.
In terms of broader thinking around your symptoms: the combination of scar tissue, restricted motion, and pain following ankle replacement is a recognised and challenging problem. The fact that hydrodilatation was limited to 11ml suggests significant capsular restriction, and adhesion formation following multiple prior surgeries is entirely plausible as a contributing factor. Depending on what your surgeon feels is appropriate, options that might be discussed include further adhesiolysis (open or arthroscopic), targeted physiotherapy under the guidance of someone experienced in post-arthroplasty rehabilitation, or in some cases revision surgery assessment — though I appreciate that after 12 prior interventions, the prospect of further surgery is understandably daunting.
My strong recommendation would be to return to your ankle replacement surgeon and present your current symptoms clearly, specifically the ongoing stiffness, the limited response to hydrodilatation, and your history of adhesion formation. If you feel you are not getting adequate traction, a second opinion from another specialist ankle arthroplasty surgeon may be worth pursuing.
I wish I could offer more directly, but I hope this at least gives you a clearer framework for the conversation ahead.
Lorenzo