Soft Tissue Scarring and Inflammation

Summary

Soft-tissue scarring involving the foot, ankle, or lower leg is common, although painful scarring and inflammation is less common. Scarring usually occurs as a result of a soft-tissue injury that causes local bruising. The bleeding in the soft-tissue clots and stiffens the surrounding tissue. A lot of this bruising will be resorbed by the body over time. However, some local scar tissue that is thicker and stiffer than the original skin and soft-tissue will remain. For most patients this scar tissue will not be painful. However, if the scarring involves structures such as fascia, muscles, tendons, or nerves the scar may create pain, particularly during movement. Most discomfort due to scar tissue can be resolved or greatly improved with therapy to mobilize the scar.

What is Soft-Tissue Scarring?

Pain and discomfort from soft tissue scarring and inflammation can happen throughout the body. However, soft-tissue scarring is particularly common in the feet, ankles, and lower leg area. These areas are commonly injured due to direct blows, and other sources of bruising. Bruising is essentially bleeding beneath the skin. Bruising can affect the fatty soft tissue that is directly below the skin; the facial tissue covering muscles; and even muscle and tendon tissues themselves. When an injury causes bruising in the foot, ankle, or lower leg, the resulting bleeding under the skin will spread throughout the nearby soft tissue and then begin to clot. This leads to a thickened, congealed blood in the affected soft-tissues. Over time, a lot of this bruising will be resorbed by the body. However, usually some scarring of the tissue under the skin will occur. The scar tissue that forms is thicker and stiffer than the normal fatty tissue under the skin. This scar tissue can cause tethering of the structures in this area –including the skin, surrounding fatty soft tissue, facial tissue, muscles, and tendons. Often, the scarred area will loosen up, and will not affect the function of the surrounding tissues, although discoloration of the skin or a subtle thickening of the soft tissue can be felt in the affected area. However, if the scarring is extensive enough or effects important structures, such as nerves, tendons, or muscles it can cause symptoms of pain and/or stiffness. These symptoms result from tethering of local structures, or increased inflammation surrounding these structures. Often areas of soft tissue scarring and inflammation are only symptomatic when the affected muscles and tendons in that area are moved during activities. However, if nerves are entrapped or tethered by the scar tissue they can create chronic symptoms of burning and pain, which may be present even at rest.

Clinical Examination of Soft-Tissue Scarring and Inflammation

Areas of painful soft tissue scarring and inflammation can usually be felt on palpation. The involved tissue will often be thicker. Normally, the skin and the underlying fatty soft tissue move independently and smoothly. However, when scar tissue forms in this area the skin and the underlying fatty tissue will move as a unit limiting the overall soft-tissue motion. There may be discomfort with direct pressure on the area of scar tissue. In patients where there is a nerve that is trapped within the scar tissue there may be a burning discomfort that radiates when the scarred area is tapped on. This is called a Tinel sign.

Treatment of Soft Tissue Scarring – Inflammation

Areas of scarring following bruising are common and are usually not symptomatic. However, if there is a painful, scarred area of soft-tissue, particularly following a local injury, treatment may be beneficial. Commonly soft tissue mobilization and local massage can be very helpful. Physical therapists have a variety of strategies to help break up scar tissue. Often a series of visits to a physical therapist can considerably improve symptoms related to soft tissue scarring and inflammation. When a nerve is entrapped in the scar creating a painful irritation to that nerve (a neuritis) treatment can be a little more challenging, although mobilizing the scar tissue and performing desensitization of the nerve is often beneficial.

Surgery to Address Soft-Tissue Scarring

In a small percentage of patients considerable symptoms may persist in spite of optimal therapy. In these patients surgery to free up the resulting area of scar tissue may be helpful. However, this type of surgery to free up scar tissue does have a real risk of creating further scar tissue at the site of surgery.

Edited January 19, 2024