Medial Malleolus Fracture and Broken Ankle Treatment
Medically reviewed by Laura Campedelli, DPT
A medial malleolus fracture 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.
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Types
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 are five types of medial malleolus fractures:
Avulsion fractures occur when a ligament pulls away from bone with a small chip or flake of bone still attached. This injury is akin to a severe ankle sprain.
Comminuted fractures are those in which a bone is broken in multiple places.
Oblique fractures often occur at the corner of the ankle joint and are a sign of an unstable ankle.
Transverse fractures are horizontally-oriented breaks in bone.
Vertical fractures As the name implies, vertical fractures are suggestive of an injury that occurs along the long axis of the bone resulting in a vertically-oriented fracture.
Causes
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 of stress 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:
Bimalleolar fractures, involving the medial malleolus and the lateral malleolus, or outer side of the ankle
Trimalleaolar fractures, involving the medial and lateral malleoli, along with the posterior malleolus, or back of the tibia
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).
Symptoms
Fractures of the medial malleolus cause symptoms such as:
Pain on the inner side of the ankle
Pain with weight-bearing that makes it difficult to walk
If these symptoms occur, make an appointment with your healthcare provider to determine the source 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 early ankle 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.
Treatment
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.
Recovery
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.
Takeaway
Following your rehabilitation program to the T is crucial. It can reduce the risk of long-term pain and complications.
As the wound heals, it's equally important to avoid infecting the surgical site and 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.
Related: Signs of Infection After Surgery
Summary
Fractures of the medial malleolus are relatively uncommon and typically occur as part of a more complex injury pattern. Non-surgical and surgical options are available, but the decision is usually determined by the alignment and stability of the fracture. Expect a minimum of six weeks and potentially as long as three to four months before you resume weight-bearing.
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 Questions
Where in the body is the medial malleolus?
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.
How common is a medial malleolus fracture?
Isolated medial malleolus fractures are relatively uncommon, but they do occur. Medial malleolus fractures are typically part of a more complex ankle injury.
Can you walk on a medial malleolus fracture?
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.
Read the original article on Verywell Health.
