Stress Fractures of the Medial Malleolus: A Case Report

Abstract

The findings for stress fracture of the medial malleolus in two patients are presented. In case 1, a 54-year-old woman complained of gradual onset of pain over the medial malleolus after prolonged walking. Magnetic resonance imaging was useful in the early detection of the stress fracture of the medial malleolus. In case 2, a 16-year-old male developed stress fracture of the medial malleolus during repetitive Kendo fencing activity. Good clinical results were obtained with nonsurgical therapy.

Sports Injuries of the Ankle

“…Standard radiographs are the fi rst step in evaluating the athlete suspected of having a medial malleolus stress fracture. These radiographs are initially negative in a maximum of 70 % of the cases and may not show evidence of stress fractures for 2-4 weeks after initiation of symptoms (Okada et al 1995 ). In more advanced cases, cortical or medullary fracture lines may be seen extending vertically or obliquely upwards at the junction of the medial malleolus and tibial plafond.…”

“…Tibia vara can lead to increased force transmission across the ankle joint by escalating the varus moment between the talus and the medial malleolus (Kor et al 2003 ). Other series report no relationship between malalignment and the incidence of medial malleolar stress fractures (Okada et al 1995 ;Orava et al 1995 ).…”

“…This rotation is then transmitted to the tibia through the medial malleolus, causing the characteristic stress fracture orientation. Okada et al believed that an abnormally small angle between the tibial shaft and plafond increases stress transmission to the medial malleolus (varus alignment) (Okada et al 1995 ). Tibia vara can lead to increased force transmission across the ankle joint by escalating the varus moment between the talus and the medial malleolus (Kor et al 2003 ).…”

“…Medial malleolus stress fractures are caused by abnormal weight transmission and torsional forces (Okada et al 1995 ). Muscular forces are believed to be no relevant on the medial side of the ankle.…”

Medial-sided Stress Fractures: Medial Malleolus and Navicular Stress Fractures

“…26,27 However, most case reports suggest that most of their patients did not have any mechanical alignment abnormalities. 28,29 Jowett et al 30 did notice that in their series of 5 elite athletes with medial malleolar stress fractures, all had anteromedial ankle impingement.…”