Ankle synovitis is the inflammation of the synovium, which is the soft tissue lining the ankle joint capsule. The synovium secretes synovial fluid into the joint to ease friction. A degree of synovitis accompanies most ankle injuries, and can be worsened by returning to weight-bearing too soon or under repetitive strain. It is common in those with ankle instability and/or flat feet.

Symptoms

Swelling and tenderness in the ankle joint. Symptoms are often worse on waking and may improve after a hot shower or warm-up exercises. Aches and pains are felt at the front, sides and sometimes the back of the ankle. Sprains that are unresolved often cause ongoing pain and stiffness.

Treatment

Rest is crucial, and many patients heal well by complying fully with appropriate rest and physiotherapy. Rest after any activity that increases pain is the vital component, and it is definitely not a case of “no pain, no gain.” The reverse is true, with ignoring symptoms leading to the condition becoming chronic and much harder to recover from.

Physiotherapy can take many forms and these may include ultrasound, soft tissue massage, exercises to improve flexibility and strength, heat or ice treatment and biomechanical correction.

Do I need an operation?

Not all patients with synovitis will need surgery. If the synovitis is not painful it does not necessarily need to be treated surgically. If  synovitis is present and painful the alternative to surgery would be to undergo a period of immobilisation in a walker boot or a cast. With regard to an operation if the synovitis is painful and does not respond to non-operative measures then surgery to deal with a painful synovitis is highly effective. Approximately 80% of patients will get a good result from surgery, but it is important in making the decision to weigh up not just the chance of getting a good result, which is very high, but also what is involved and also the risks of any procedure. This is fully discussed at the consultation alongside the other treatment options in order that you are able to make a sensible decision regarding any treatment that may be needed for the synovitis.

If I need an operation what is involved?

If surgery is needed for synovitis, this generally takes the form of keyhole surgery. An arthroscopy of the ankle is carried out. The area of damage is prepared and small perforations are made in the bone to allow for bleeding and the development of new cartilage to take the place of the old damaged cartilage. The operation takes between thirty to ninety minutes. The operation is generally carried out as a day-case but may require an overnight stay. Following surgery, the ankle is immobilised in a walker boot or a plaster cast for approximately six weeks.

Following an operation how long will I be in hospital?

Surgery for synovitis is generally done as a day-case. Sometimes an overnight stay is required following which you would be allowed home the following morning.

How long will it be before I can get back to work or sports?

Following keyhole surgery for synovitis, return to work may be possible approximately two weeks following the procedure. Consideration to transport and driving to and from work needs to be taken into account particularly if the right leg has been the one that has been treated. The requirement for immobilisation in a walker boot or cast is for six weeks. Return to sports is at approximately three to six months for heavier sports, but for more gentle sports / low impact sports generally it is about two to three months following surgery.

Will I need any physiotherapy?

After surgery for synovitis, you will require physiotherapy to strengthen the ankle and leg. Generally, between six and ten sessions of physiotherapy will be needed following this type of keyhole surgery for synovitis.

What are the risks of the operation?

All surgery carries elements of risk and surgery for synovitis is no different. Risks include infection, clots, nerve or vessel injury and complex pain. It is important to weigh up the risks of surgery set against what is involved and also the benefits and chance of success. Considering risks is part of the decision-making process for any surgical treatment.