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What is a stress fracture of the medial malleolus?
The medial malleolus is the bony bump on the inside aspect of the ankle. A stress fracture of the medial malleolus is an incomplete fracture or crack within this bony bump. Physiotherapy is a successful treatment for a stress fracture of the medial malleolus.
How does a stress fracture of the medial malleolus happen?
Stress fractures of the medial malleolus are caused by an imbalance between bone formation and bone resorption (removal). When the medial malleolus is loaded or stressed, such as during weight-bearing exercise, it responds by increasing its bone turnover. This is necessary for it to live up to your demands on it.
Above: Passive stretch of the achilles tendon performed by specialist therapistIf stress is put on the medial malleolus, areas of the bone can become damaged. These damaged areas of bone are then resorbed (removed) and replaced with new bone. If the new bone formation is slower than the resorption (removal) of the old bone, weak points occur at areas of stress within the medial malleolus. An area of weakness in the bone can develop into a stress fracture if the weak area of the medial malleolus is repeatedly stressed.
A recent change in training can often be a factor in the development of a stress fracture. This could involve a change in frequency, duration, intensity, training surfaces or footwear.
What are the symptoms of a stress fracture of the medial malleolus?
A stress fracture of the medial malleolus causes an increasing amount of pain that develops over a period of weeks. The pain is felt at a specific point on the inside aspect of the ankle and is worsened by exercise. Initially, the pain may only be present following activity. With continued exercise, and stress through the bone, the pain may become present during exercise. The pain can reach a point at which activity is too painful to perform and the inside of the ankle is sore during walking, rest and even during the night. When you touch the specific point of your pain it may be tender, red and warm. Additional symptoms include:
What should I do if I have a stress fracture of the medial malleolus?
If you have or suspect you have a stress fracture of the medial malleolus, you should call to arrange a physiotherapy assessment.
Above: Progressive strengthening exercises for the foot and ankle, supervised by specialist physiotherapistWhat shouldn’t I do if I have a stress fracture of the medial malleolus?
If you suspect that you have a stress fracture of the medial malleolus, you should not continue to exercise. A stress fracture is an area of weakness within the bone. If you continue to exercise your bone could weaken further, leading to a larger stress fracture or potentially a complete bone fracture.
Physiotherapy treatment following a stress fracture of the medial malleolus.
Physiotherapy is important in the treatment of a stress fracture of the medial malleolus. Initially, your physiotherapist can provide you with a diagnosis. This may require the referral for imaging techniques such as a MRI scan. Following your diagnosis, your physiotherapist will develop an appropriate treatment plan. This may initially involve a period of rest and the use of crutches and icing to help with your pain. A programme will be developed to allow you to maintain your cardiovascular fitness and muscle strength without delaying healing. This may involve low impact ‘cross training’, swimming, deep water running and cycling. Your physiotherapist may also be able to determine why you developed a stress fracture of the medial malleolus in the first place and address this during your recovery to prevent a recurrence when you return to full activity. Other treatments include:
Could there be any long-term effects from a stress fracture of the medial malleolus?
A stress fracture of the medial malleolus does not cause any long-term effects if it is properly treated, and the cause identified and addressed. If you do not seek treatment and continue to exercise you may be at risk of a larger crack, a complete bone fracture or further stress fractures when you re-commence participation.
To arrange an assessment with a specialist physiotherapist call Physio.co.uk on 0330 088 7800 or book online.
