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Stress Fracture of the Medial Malleolus

Injuries > Ankle > Stress Fracture of the Medial Malleolus

 

(Also known as Medial Malleolar Stress Fracture, Stress Fracture of the Tibia, Tibial Stress Fracture)

 

What is a stress fracture of the medial malleolus?

The bony lump on the inside of the ankle is known as the medial malleolus. This arises from the lower end of the shin bone (tibia figure 1). During weight bearing activity compressive forces are placed through the medial malleolus. When these forces are excessive or too repetitive and beyond what the bone can withstand, bony damage gradually occurs. This initially results in a bony stress reaction, however, with continued damage may progress to a stress fracture of the medial malleolus.

Causes of a stress fracture of the medial malleolus

Stress fractures of the medial malleolus typically occur over time with excessive weight bearing activity such as running. They often present following a recent increase in activity or change in training conditions.

Signs and symptoms of a stress fracture of the medial malleolus

Patients with a stress fracture of the medial malleolus typically experience localised pain on the inner aspect of the ankle that increases with impact activity such as running or jumping. In severe cases, walking may be enough to aggravate symptoms and may cause the patient to limp. Other symptoms may include night ache or pain on firmly touching the affected bone.

Diagnosis of a stress fracture of the medial malleolus

A thorough subjective and objective examination from a physiotherapist may be sufficient to diagnose a stress fracture of the medial malleolus. Investigations such as an MRI, CT scan or bone scan are usually required to confirm diagnosis.

Treatment for a stress fracture of the medial malleolus

Treatment for a stress fracture of the medial malleolus typically involves an initial period of rest from weight bearing activity. This may include the use of crutches, a protective boot, an air-cast brace or plaster cast immobilization. This initial period of reduced weight bearing may be for up to 6 weeks. Following this, a gradual increase in weight bearing activity and exercise can usually occur provided symptoms do not increase. This should take place over a period of weeks to months with direction from the treating physiotherapist and will vary depending on the severity of the injury.

Alternative exercises placing minimal weight bearing forces through the affected bone should be performed to maintain fitness such as swimming, cycling, and water running. Exercises to maintain flexibility, strength and balance are also important to ensure the ankle and lower leg are functioning correctly. The treating physiotherapist can advise which exercises are most appropriate and when they should be commenced.

Contributing factors to the development of a stress fracture of the medial malleolus

There are several factors that may contribute to the development of a stress fracture of the medial malleolus. These should be assessed and where possible corrected with direction from the treating physiotherapist and may include:

  • poor foot biomechanics
  • inappropriate or excessive training (particularly on hard or uneven surfaces)
  • muscle weakness
  • poor flexibility
  • joint stiffness
  • inappropriate footwear 
  • poor balance

Physiotherapy for a stress fracture of the medial malleolus

Physiotherapy treatment is essential for all patients with a stress fracture of the medial malleolus to hasten healing, prevent recurrence and ensure an optimal outcome. Treatment may comprise: 

  • soft tissue massage
  • joint mobilization
  • electrotherapy (e.g. ultrasound)
  • taping or bracing
  • the use of crutches or a protective boot
  • biomechanical correction
  • exercises to improve strength, balance and flexibility
  • education
  • a graduated return to activity plan

Other intervention for a stress fracture of the medial malleolus

A review with a podiatrist may be indicated for appropriate orthotics and footwear advice. Occasionally, a specialist review may be indicated in patients who are not progressing adequately. The treating physiotherapist can advise if either of these is required.

Exercises for a stress fracture of the medial malleolus

The following exercises are commonly prescribed to patients with a stress fracture of the medial malleolus. You should discuss the suitability of these exercises with your physiotherapist prior to beginning them. Generally, they should be performed 3 times daily and only provided they do not cause or increase symptoms.

Foot and Ankle Up and Down

Move your foot and ankle up and down as far as possible and comfortable without pain (figure 2). Repeat 10 - 20 times provided there is no increase in symptoms.

Exercises for a Stress Fracture of the Medial Malleolus- Foot & Ankle Up & Down

Figure 2 Foot and Ankle Up and Down (left leg)

Foot and Ankle In and Out

Move your foot and ankle in and out as far as possible and comfortable without pain (figure 3). Repeat 10 - 20 times provided there is no increase in symptoms.

Exercises for a Stress Fracture of the Medial Malleolus - Foot & Ankle In & Out

Figure 3 Foot and Ankle In and Out (right leg)

Foot and Ankle Circles

Move your foot and ankle in a circle as large as possible and comfortable without pain (figure 4). Repeat 10 times in each direction provided there is no increase in symptoms.

Exercises for a Stress Fracture of the Medial Malleolus - Foot & Ankle Circles

Figure 4 Foot and Ankle Circles

 

Physiotherapy products for a stress fracture of the medial malleolus

Some of the most commonly recommended products by physiotherapist to hasten healing and speed recovery in patients with a stress fracture of the medial malleolus include:

  1. Crutches
  2. Protective Boots
  3. Ankle Braces
  4. Ankle Supports
  5. Ice and Heat Packs
  6. Wobble Boards (for rehabilitation)
  7. Dura Discs (for rehabilitation)
  8. Resistance Band (for strengthening)
  9. Sports Tape (for protective taping)

To purchase physiotherapy products for a stress fracture of the medial malleolus click on one of the above links or visit the PhysioAdvisor Shop.

 

More information

Find a Physio for a stress fracture of the medial malleolus

Find a Physiotherapist in your local area who can a stress fracture of the medial malleolus.

 

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Medial Malleolus and Tibia

Figure 1 - Medial malleolus and tibia

 

Ankle Braces

 

Ankle Supports

 

Wheat Heat Pack

 

Crutches Ad

 

Wobble Boards

 

Dura Discs

 

Sports Tape 38mm

 

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