What is a Medial Malleolus Fracture?
The medial malleolus supports the inner side of the ankle joint. A medial malleolus fracture is a break in the tibia and can occur at any level (inside the lower leg). For example, fractures of the fibula (internal malleolus), a fracture of the back of the tibia (posterior malleolus), or with an injury to the ankle ligaments. Injuries to the ankle ligaments are also called stress fractures, which are uncommon in the general population. In these cases, there are no forceful injuries. Rather, the repetitive stress of an activity causes the bone to weaken. Stress fractures of the ankle are most often seen in endurance athletes and military recruits. To learn more about malleolus fractures, read the information below.
Causes
● When the foot is forcefully rolled inward or outward
● Repetitive stress from any activity that causes the bone to weaken
Signs and Symptoms
● Pain on the inner side of the ankle
● Swelling and bruising of the foot and ankle
● Difficulty walking
● Pain is worse by running and jumping activities
Diagnosis
Your healthcare provider will assess your symptoms and test you for signs of a more serious unstable ankle fracture.
Treatment
1). Non-surgical
● Stress Xray fracture done if stable
● If fracture is not out of place or there are small fractures, then the treatment plan may entail:
○ Short leg cast,
○ Removable brace,
○ Non-weight bearing for approximately 6 weeks,
○ Follow-up with your physician regularly for repeat x-rays to make sure the fracture does not change position.
2). Surgical
● If unstable or bones are out of place
● Can be done to reduce the risk of the fracture not healing (nonunion).
● To allow you to start moving the ankle earlier
● Medial malleolus fracture can impact or indent the ankle joint.
○ Impact: occurs when a force is so great it drives the end of one bone into another one.
○ Repairing: impact fracture may require bone grafting, which acts as a scaffolding for new bone to grow on, may lower any later risks of developing arthritis.
○ Bone fragments may be fixed using screws, a plate and screws, or different wiring techniques.
Complications
It is important that medial malleolar stress fractures be diagnosed and treated early to enable athletes to return to their sports quickly. Failure to assess and manage the fracture properly can result in complications such as:
● Fracture progression
● Delayed healing
● Nonunion
● Chronic pain
● Delayed return to their athletic lives
After a period of rest, ankle strengthening, and proprioception exercises should be done to restore full
strength and coordination to the ankle joint preventing future injuries. This should be gradual and take up to 12 weeks.
References
American Academy of Orthopaedic Surgeons. (2022). Medial Malleolus Fracture. https://orthoinfo.aaos.org/en/diseases–conditions/ankle-fractures-broken-ankle/
Lee, H. S., Lee, Y. K., Kim, H. S., Lee, D. W., Won, S. H., Jung, K. J., Kim, C. H., & Kim, W. J. (2019). Medial malleolar stress fracture resulting from repetitive stress caused by lateral ankle instability: A case
report. Medicine, 98(5), e14311. https://doi.org/10.1097/MD.0000000000014311
MiMWoWSiNstudio. (2022). [Xray]. Left Distal Medial Malleolus Fracture X-ray After Involving In A
Motor Vehicle Accident. https://www.shutterstock.com/image-photo/left-distal-medial-malleolus-
fracture-xray-2104961150