Ankle pain after uncomplicated ankle fractures poses a diagnostic and therapeutic challenge, especially in joints that exhibit insignificant radiographic changes. Ankle joint arthroscopy has become an important diagnostic and therapeutic tool for such cases. Adhesion of the distal tibiofibular syndesmosis, as yet an undescribed entity, was found to be the cause of chronic ankle pain in 11 of 19 patients suffering from chronic ankle pain after an uncomplicated fracture of the ankle. Symptoms resolved after arthroscopic resection of the adhesions in all 11 patients. Arthroscopy has an important role in diagnosis and management of unexplained ankle pain after a seemingly uncomplicated fracture.