@janieben I had a bad ankle fracture in 2020 with both the tibia and fibula fractured. It was also compound with the fibula breaking through the skin and dislocation of the joint. It has been a difficult recovery that has been like living with a sprained ankle for 4 years that limited how much I could do before I had to get off my ankle. The scar tissue is significant because of the surgeries to fix the ankle.

First there was an external cage screwed into the front of the tibia and both sides of the heel bone to stabilize it for a couple weeks before it could be fixed in surgery. Then surgery that placed plates and screws on the tibia in a new incision and also used the incision from the broken fibula when they had cleaned that wound. This second surgery also placed a screw inside the fibula. At a year and a half past the fracture, I chose to have all the hardware removed because it was causing throbbing pain, giving me large patches of hives, and developing some pigmentation on the skin over where the plates were. They used the same incision scars to cut for the next surgery.

What would happen sporadically was my ankle would collapse in pain when I was stepping off of it, and I would end up having to get off my foot and rest. I had learned a lot about stretching scar tissue from my physical therapist, and I used her techniques of myofascial release to work on the scar tissue on my ankle and shin and to loosen the tight muscle in the calf and shin. The injured side is of course weaker, and the stronger side kind of pulls on the weaker side putting excess tension on the ligaments and tendons on the weak side. I started to try to equalize that tension by working on the scar tissue and muscle tighness, and that worked. I was able to cure the pain and walk without pain for the first time in 4 years. This lets me rebuild strength slowly now that my joint is held in better alignment because the uneven tension has been worked out. I also got more supportive shoes that come up farther on my ankle and I moved my orthotic inserts into those shoes. It has helped a lot.

I had a bad injury called a bimaleolar frature which in simple terms means I broke off the "knobs" off on both sides of the ankle. The tibia on the front also had a compression that caused pieces like "puzzle pieces", but those that not been displaced.

The scar tissue led to this by being too tight and pulling through the front of the joint causing it to pinch and cause the pain. The subsequent surgeries also used the same scars for new incisions. The scar over the fibula had been cut 3 times, the scar on the inside of the tibia had been cut twice, and the scars from the external cage were cut once, but were very deep piercing the muscle on the front of the shin and adhering to the tibia bone. By loosening all of this, my ankle is now able to operate better and to stay in alignment better. I do circle my foot around to kind of reset it, and sometimes use distraction by pulling on my foot downward away from the leg.

There certainly can be arthritis after an injury like this, and my surgeon promised that would happen and I could expect to become a candidate for an ankle replacement in the future. I am determined to prevent that. If I can keep it moving better and use supportive shoes with my custom orthotics, I can stay out of pain. I am now working on walking more and adding in hills and uneven ground. That had always been a problem when the tension was unequal on the links that connect all the muscle to the bones (Tendons), and bones to bones (Ligaments). With stronger muscles, hopefully the joint will be held in better alignment. Pain can be caused by scar tissue and also reactions to the metal hardware. Some patients don't tolerate foreign materials inside their body very well, and that is me. Since removing my hardware from my ankle and doing the physical therapy work, I am now pain free.

Here is our discussion on myofascial release that can give you more information.

Neuropathy - "Myofascial Release Therapy (MFR) for treating compression and pain"
https://connect.mayoclinic.org/discussion/myofascial-release-therapy-mfr-for-treating-compression-and-pain/
There is a provider search at https://myofascialrelease.com/

Has your physical therapist talked about releasing scar tissue? Has your surgeon discussed the possibility of the hardware itself causing pain?