Medial Malleolus Fracture
(Also known as Tibia Fracture, Fractured Tibia, Fractured Medial Malleolus, Broken Tibia, Ankle Fracture)
What is a medial malleolus fracture?
A medial malleolus fracture is a condition characterized by a break in the bony process situated at the inner aspect of the ankle known as the medial malleolus (figure 1).
Figure 1 – Medial Malleolus Fracture Anatomy
The lower leg comprises of 2 long bones, known as the tibia and the fibula, which are situated beside each other (figure 2). The tibia bone lies on the inner aspect of the lower leg and forms joints with the femur (i.e. the thigh bone, at the knee), the fibula (near the knee and at the ankle) and the talus in the ankle (figure 2). The tibia has a bony process situated at the inner aspect of the ankle known as the medial malleolus (figure 1).
Figure 2 – Tibia, Fibula and Talus Anatomy
During certain activities such as landing from a jump, a forceful impact to the inner aspect of the ankle or when rolling an ankle, stress is placed on the tibia and medial malleolus. When this stress is traumatic and beyond what the bone can withstand, a break in the medial malleolus may occur. This condition is known as a medial malleolus fracture.
Because of the large forces required to break the tibia, a medial malleolus fracture often occurs in combination with other injuries such as a sprained ankle or other fractures of the foot, ankle or lower leg.
Medial malleolus fractures can vary in location, severity and type including avulsion fracture, stress fracture, Potts’ fracture, displaced fracture, un-displaced fracture, compound fracture, greenstick, comminuted etc.
Causes of a medial malleolus fracture
A medial malleolus fracture often occurs in association with a rolled ankle particularly with significant weight bearing forces. They may also occur due to an awkward landing from a jump (particularly on uneven surfaces), due to a fall or following a direct blow to the front or inner aspect of the lower leg or ankle. Medial malleolus fractures occasionally occur in running and jumping sports involving change of direction such as football, soccer, rugby, basketball and netball. A stress fracture of the medial malleolus may occur as a result of overuse often associated with a recent increase or high volume of running.
Signs and symptoms of a medial malleolus fracture
Patients with a medial malleolus fracture typically experience a sudden onset of sharp, intense inner ankle or lower leg pain at the time of injury. This often causes the patient to limp so as to protect the medial malleolus. In severe cases, particularly involving a displaced fracture of the medial malleolus, weight bearing may be impossible. Pain is usually felt on the front or inner aspect of the ankle or lower leg and can occasionally settle quickly with rest leaving patients with an ache at the site of injury that may be particularly prominent at night or first thing in the morning. Occasionally patients may experience symptoms in the Achilles or calf region.
Patients with a medial malleolus fracture may also experience swelling, bruising and pain on firmly touching the affected region of bone. Pain may also increase during certain movements of the foot or ankle or when standing or walking (particularly up hills or on uneven surfaces) or when attempting to stand or walk. In severe medial malleolus fractures (with bony displacement), an obvious deformity may be noticeable. Occasionally patients may also experience pins and needles or numbness in the lower leg, foot or ankle.
Diagnosis of a medial malleolus fracture
A thorough subjective and objective examination from a physiotherapist is essential to assist with diagnosis of a medial malleolus fracture. An X-ray is usually required to confirm diagnosis and assess the severity of the fracture. Further investigations such as an MRI, CT scan or bone scan may be required, in some cases, to assist with diagnosis and assess the severity of the injury.
Treatment for a medial malleolus fracture
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Prognosis of a medial malleolus fracture
Patients with a medial malleolus fracture usually make a full recovery with appropriate management (whether surgical or conservative). Return to activity or sport can usually take place in a number of weeks to many months and should be guided by the treating physiotherapist and specialist. In patients with severe injuries involving damage to other bones, soft tissue, nerves or blood vessels, recovery time may be significantly prolonged. In patients with only very minor fractures that are un-displaced (such as an avulsion fracture of the medial malleolus) return to sport can sometimes occur in as little as 6 – 8 weeks as guided by the treating physiotherapist.
Physiotherapy for a medial malleolus fracture
Physiotherapy treatment is vital in all patients with a medial malleolus fracture to hasten healing and ensure an optimal outcome. Treatment may comprise:
- soft tissue massage
- joint mobilization
- dry needling
- ice or heat treatment
- ankle taping
- use of a protective boot or ankle brace
- the use of crutches
- the use of heel wedges
- exercises to improve strength, flexibility and balance
- electrotherapy (e.g. ultrasound)
- activity modification advice
- dietary advice to aid fracture healing
- a graduated return to activity plan
- footwear advice
Other intervention for a medial malleolus fracture
Despite appropriate physiotherapy management, some patients with a medial malleolus fracture do not improve adequately and may require other intervention. The treating physiotherapist or doctor can advise on the best course of management when this is the case. This may include further investigations such as X-rays, CT scan, MRI or bone scan, periods of plaster cast immobilization, pharmaceutical intervention, review with a podiatrist for possible orthotics or referral to appropriate medical authorities who can advise on any intervention that may be appropriate to improve the fractured medial malleolus. Occasionally, patients with fractures that are initially managed without surgical intervention may require surgery to stabilize the fracture and a bone graft to aid fracture healing.
Exercises for a medial malleolus fracture
The following exercises are commonly prescribed to patients with a medial malleolus fracture following confirmation that the fracture has healed or that pain free mobilization can commence as directed by the orthopaedic specialist. 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.
Your physiotherapist can advise when it is appropriate to begin the initial exercises and eventually progress to the intermediate, advanced and other exercises. As a general rule, addition of exercises or progression to more advanced exercises should take place provided there is no increase in symptoms.
Foot and Ankle Up and Down
Move your foot and ankle up and down as far as you can go without pain and provided you feel no more than a mild to moderate stretch (figure 3). Repeat 10 – 20 times provided there is no increase in symptoms.
Figure 3 – 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 you can go without pain and provided you feel no more than a mild to moderate stretch (figure 4). Repeat 10 – 20 times provided there is no increase in symptoms.
Figure 4 – Foot and Ankle In and Out (right leg)
Foot and Ankle Circles
Move your foot and ankle in a circle as far as you can go without pain and provided you feel no more than a mild to moderate stretch (figure 5). Repeat 10 times in each direction provided there is no increase in symptoms.
Figure 5 – Foot and Ankle Circles
Rehabilitation Protocol for a Medial Malleolus Fracture
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Physiotherapy products for a medial malleolus fracture
Some of the most commonly recommended products by physiotherapist to hasten healing and speed recovery in patients with this condition include:
- Walking Sticks
- Protective Boots
- Ankle Braces
- Ankle Supports
- Ice and Heat Packs
- Heel Wedges
- Wobble Boards or Duradiscs (for Balance Exercises)
- Bosu Balls (for Balance Exercises)
- Swiss Balls (for core stability exercises)
- Resistance Band (for strengthening exercises)
- Sports Tape (for Ankle Taping or Arch Support Taping)
- Compression Bandages
To purchase physiotherapy products for a medial malleolus fracture click on one of the above links or visit the PhysioAdvisor Shop.
Find a Physio for a Medial Malleolus Fracture
Find a physiotherapist in your local area who can treat this condition.
More Useful Exercises
- How to use Crutches
- Ice or Heat?
- The R.I.C.E. Regime
- Choosing a Shoe
- Do I Need Orthotics?
- Ankle Taping
- Achilles Tendon Taping
- Arch Support Taping
- Return to Running Program
- Return to Sport
- Warming up and Cooling Down
- Injury Prevention
- Ankle Diagnosis Guide
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A medial malleolus fracture is a condition characterized by a break in the bony process situated at the inner aspect of the ankle known as the medial malleolus and typically causes severe inner ankle pain at the time of injury. Accurate diagnosis followed by a comprehensive physiotherapy rehabilitation program is vital to optimise recovery.
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