Physiotherapy Management of a Hypertrophic Ankle Scar After Debridement: A Case Report

Abstract

Background: Hypertrophic scars can restrict joint mobility and impair functional outcomes, particularly near highly mobile joints. Reports describing physiotherapy management of ankle hypertrophic scars after debridement are limited.
Objective: To describe the clinical response to physiotherapy in a patient with a right ankle hypertrophic scar following debridement.
Methods: This case involved a 44-year-old woman with a four-month history of a hypertrophic scar after right ankle debridement. She presented with edema, paresthesia, restricted ankle range of motion, reduced muscle strength, and functional limitations. Six sessions were provided over two weeks, including therapeutic ultrasound, scar mobilization, active and active-assisted range of motion exercises, ankle pumping, gastrocnemius stretching, strengthening exercises, and therapeutic communication. Outcomes included ankle range of motion, paresthesia, Vancouver Scar Scale, Hamilton Anxiety Rating Scale, Barthel Index, edema grade, girth circumference, and manual muscle testing.
Results: Dorsiflexion increased from 15° to 30°, plantarflexion from 35° to 40°, inversion from 10° to 30°, and eversion from 5° to 15°. Paresthesia decreased from 8 to 2, Vancouver Scar Scale score from 10 to 6, and Hamilton Anxiety Rating Scale score from 10 to 3. Barthel Index increased from 90 to 99 and manual muscle testing from 3 to 5, while girth circumference difference decreased from 5 cm to 1 cm. Pitting edema improved from grade II to grade I.
Conclusion: The multimodal physiotherapy program was associated with improvements in mobility, edema, sensory symptoms, functional status, muscle strength, anxiety, and scar characteristics. Long-term outcomes could not be evaluated because no post-treatment follow-up was available.