Table of ContentsView AllTable of ContentsTypesCausesSymptomsTreatmentRecoveryFrequently Asked Questions
Table of ContentsView All
View All
Table of Contents
Types
Causes
Symptoms
Treatment
Recovery
Frequently Asked Questions
Amedial malleolusfracture can happen during activity when your foot collapses inward or rotates too far outward. Fractures of the medial malleolus are relatively uncommon. When they do occur, they are usually part of a more complex pattern of ankle fractures.
This article explains what medial malleolus fractures are, as well as their causes and symptoms. It also addresses treatment options and their potential complications.
Sopone Nawoot / Getty Images
The medial malleolus is the bony bump on the inner side of the ankle. This is the end of the shinbone (tibia) and forms the support for the inner side of the ankle joint. The medial malleolus is also the attachment of the major ligament on the inner side of the ankle, called the deltoid ligament.
There arefive types of medial malleolus fractures:
An isolated fracture of the medial malleolus generally occurs when the foot is forcefully rolled inward or outward.When the foot rolls inward, it causes a compression of the medial malleolus on the inner side of the ankle. When the foot rolls out, it puts tension on the medial malleolus, which can also cause a fracture.
The medial malleolus can also be a site ofstress fractures.In these cases, the fracture is due to repetitive stress, rather than a forceful injury. Stress fractures of the foot and ankle are most commonly seen in endurance athletes and military recruits, as well as people with osteoporosis (low bone density).
A medial malleolus fracture can also happen as part of a pattern of ankle fractures, including:
Anatomy of the AnkleThe ankle joint consists of three bones: the shinbone (tibia); the smaller bone of the lower leg(fibula); and a small bone that is nestled between the heel and these two bones (talus).
Anatomy of the Ankle
The ankle joint consists of three bones: the shinbone (tibia); the smaller bone of the lower leg(fibula); and a small bone that is nestled between the heel and these two bones (talus).
The ankle joint consists of three bones: the shinbone (tibia); the smaller bone of the lower leg
(fibula); and a small bone that is nestled between the heel and these two bones (talus).
Fracturesof the medial malleolus cause symptoms such as:
If these symptoms occur, make an appointment with your healthcare provider to determine thesource of your ankle pain. There are well-established criteria to determine if an X-ray is necessary. Most fractures are readily visible on X-rays, so further tests usually aren’t needed.
A medial malleolus fracture prompts concern about other possible damage to the joint that may occur as part of typical injury patterns.This can include bones as well as ligaments (the tissues that connect bone to bone) and tendons (tissues that connect muscle to bone).
Any patient with a medial malleolus fracture should be carefully examined so the full extent of an injury can be confirmed.
Complications
Long-term, this type of injury can lead to earlyankle arthritis—even if the bone heals well (which most do) and is properly treated. Ankle arthritis causes symptoms such as pain with movement, joint stiffness, and difficulty putting weight on the ankle.
This can happen if cartilage inside the ankle joint is also damaged at the time of the injury.
There are both surgical and non-surgical options to treat medial malleolus fractures. The one that is best for you depends on how the fracture has impacted the ankle joint.
Immobilization
Immobilizing a fracture (meaning, reducing or eliminating motion) is often preferred if the fragment of bone is too small to negatively affect the overall stability of the alignment of the joint.
Fractures usually are treated with a short leg cast or a removable brace, often called a boot.
Several studies have documented proper healing of medial malleolus fractures without surgery. In most of these cases, the ankle joint was not out of position.
Surgery
In general, most healthcare providers only recommend surgery for fractures that can affect the stability or the alignment of the joint.
Surgery is usually done immediately, before any swelling has developed, or after days or even weeks of waiting for the swelling to subside. Time allows the soft tissues to become healthy again at the time of the procedure, which can reduce surgical risks.
For fractures that are not well-positioned, a surgical procedure to line up and stabilize the bone is often recommended.The bone usually is held in position with metal screws, although there are several other options that can be considered based on the particular fracture pattern. These include placement of a plate and screws or wiring techniques.
Depending on the type of fracture, your surgeon may be able to directly visually inspect the cartilage during the surgery to look for signs of damage. Other surgeons may opt to perform an ankle arthroscopy at the time of repair to better see the cartilage. This minimally invasive procedure involves making two small incisions to gain access to the ankle joint.
It takes at least six weeks for a broken bone to heal. More time will be added to your recovery if any ligaments or tendons have been damaged. Expect your healthcare provider to monitor your progress with more X-rays.
The ankle joint is treated with particular caution after surgery because only a thin layer of skin covers the surgical repair. To guard it as it heals, you can expect to be placed in a splint before moving on to a removable brace or cast.
Whether you follow a surgical or non-surgical treatment plan, physical therapy will probably play a big role in your recovery. When you’re ready, you will begin to exercise and strengthen your ankle.
The rehabilitation process can take time. You may be able to start putting weight on your ankle as early as three to six weeks after surgery.Your healthcare provider will be watching carefully and will not give you the all-clear until your ankle is stable enough.
It’s natural to become impatient during this period. But it’s vital not to put weight on your ankle prematurely because it could cause your surgical repair to fail completely. If that happens, you would have to begin the process all over again.
As the wound heals, it’s equally important to avoidinfecting the surgical siteand to follow all of your physician’s instructions regarding physical therapy, activity level, proper rest, and wound care.
The speed and quality of your recovery depend on your diligence.
Signs of Infection After Surgery
Summary
A Word From Verywell
Try to remember that dealing with an ankle fracture can be tricky: You need to give it time to heal properly, but your ankle won’t get stronger without proper exercise.
If you’re not sure if you’re doing what’s best for your recovery, speak to your healthcare team. Be sure to keep them in the loop about any problems you may have following their recommendations, as well as any setbacks you may encounter.
Frequently Asked QuestionsThe medial malleolus is at the end of the tibia. It is the bony bump on the interior side of the ankle that provides support for that side of the ankle joint.Isolated medial malleolus fractures are relatively uncommon, but they do occur. Medial malleolus fractures are typically part of a more complex ankle injury.It depends on the severity. With a chip or avulsion fracture, once you have a walking cast or boot, you may be able to put pressure on the foot after a day or two, depending on your pain level. Severe fractures often require surgery. With these, you’ll need to be off your feet for several weeks.
The medial malleolus is at the end of the tibia. It is the bony bump on the interior side of the ankle that provides support for that side of the ankle joint.
Isolated medial malleolus fractures are relatively uncommon, but they do occur. Medial malleolus fractures are typically part of a more complex ankle injury.
It depends on the severity. With a chip or avulsion fracture, once you have a walking cast or boot, you may be able to put pressure on the foot after a day or two, depending on your pain level. Severe fractures often require surgery. With these, you’ll need to be off your feet for several weeks.
10 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Vannabouathong C, Ayeni O, Bhandari M.A narrative review on avulsion fractures of the upper and lower limbs.Clin Med Insights Arthritis Musculoskelet Disord. 2018 Nov;11(1):1-10. doi:10.1177/1179544118809050
Lampridis V, Gougoulias N, Sakellariou A.Stability in ankle fractures: Diagnosis and treatment.EFORT Open Rev. 2018;3(5):294-303. doi:10.1302/2058-5241.3.170057.
De Luna V, Caterini A, Casci C, et al.Clinical and radiological results after fracture-dislocations of the ankle: A medium- to long-term followup study.J Funct Morphol Kinesiol. 2022 Jun;7(2):30. doi:10.3390/jfmk7020030
Alazzawi S, Sukeik M, King D, Vemulapalli K.Foot and ankle history and clinical examination: A guide to everyday practice.World J Orthop. 2017;8(1):21-29. doi:10.5312/wjo.v8.i1.21.
Matson AP, Barchick SR, Adams SB.Comparison of open reduction and internal fixation versus closed reduction and percutaneous fixation for medial malleolus fractures.J Am Acad Orthop Surg Glob Res Rev. 2017;1(8):e048. doi:10.5435/JAAOSGlobal-D-17-00048.
Goost H, Wimmer MD, Barg A, Kabir K, Valderrabano V, Burger C.Fractures of the ankle joint: investigation and treatment options.Dtsch Arztebl Int.2014;111(21):377-88. doi:10.3238/arztebl.2014.0377.
American Academy of Orthopaedic Surgeons.Ankle fractures (broken ankle).
Passias B, Korpi F, Chu A, et al.Safety of early weight bearing following fixation of bimalleolar ankle fractures.Cureus. 2020 Apr;14(4):e7557. doi:10.7759/cureus.7557
Meet Our Medical Expert Board
Share Feedback
Was this page helpful?Thanks for your feedback!What is your feedback?OtherHelpfulReport an ErrorSubmit
Was this page helpful?
Thanks for your feedback!
What is your feedback?OtherHelpfulReport an ErrorSubmit
What is your feedback?
