Stress fractures of the medial malleolus are not commonly seen and account for 10% of stress fractures seen in the foot and ankle.
Stress fractures of the medial malleolus are not commonly seen and account for 10% of stress fractures seen in the foot and ankle. The medial malleolus is prone to the development of stress fractures due to the compressive sheer stresses placed across the tibia specifically due to running and jumping. The repetitive microtrauma can overwhelm the body's ability to repair itself, which leads to the development of a stress fracture.
Stress fractures of the medial malleolus are considered a high-risk stress fracture. They are at high risk for delayed union, nonunion, and for fracture progression. CT images of progressing medial malleolus stress fracture Patients will typically begin to complain about gradual pain over a 2-3 week time period.
A detailed history will need to be taken looking at changes of activity, shoeware, symptoms consistent with malabsorption, dietary intake history, and supplement use. Physical exam will involve palpation of the distal tibia. Patients will typically complain of pain to palpation over the medial malleolus.
Risk factors for the development of medial malleolar stress fractures include spurring of the anteromedial and distal tibia, board talar neck, and a varus lower limb alignment (4,5). MRI with medial malleolus bone marrow edema Standard radiographs typically miss the early signs of a stress fracture. However, an MRI without contrast will show signs of marrow edema and a possible fracture line earlier than an xray.
Standard radiograph showing complete medial malleolus fracture In patients with an incomplete fracture line, they can be treated non operatively. This would include a period of time non weight bearing. These patients are at risk of nonunion due to high sheer stress through the distal tibia and some will require surgical treatment.
If you are experiencing symptoms that may be related to medial malleolus stress fracture, it is important to see a sports medicine physician. Early evaluation and treatment typically lead to better outcomes. Do not ignore pain or symptoms that are limiting your activity.
*This article is for educational purposes only and does not substitute for professional medical advice. Always consult a qualified healthcare provider.*
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