Ankle Fractures (Medial) Causes, Symptoms & Treatment

Overview

The medial malleolus is the bony prominence on the inner side of the ankle and forms the lower end of the tibia (shin bone), which supports about 90% of the body’s weight.

An isolated medial malleolus fracture is uncommon and often occurs alongside a break in the fibula, the slender bone on the outer side of the ankle. If you experience pain localized to the inner ankle and find it difficult to bear weight, it may indicate a fracture or break of the medial malleolus.

What causes Ankle Fractures (Medial)?

Medial ankle fractures often result from a twisting, rolling, or impact injury that places excessive stress on the inner ankle. These fractures can occur suddenly, such as from a fall, sports-related collision, or car accident.

How the Injury Occurs: The injury usually happens when the foot twists sharply inward or outward while bearing weight. This motion places significant force on the inner side of the ankle, leading to a crack or a complete internal malleolus break. High-impact trauma, such as car accidents or falls from a height, can also fracture the bone directly.

• Common Everyday Causes: Medial ankle fractures can also occur in everyday situations. Slipping on a wet floor, missing a step while walking downstairs, or stepping awkwardly off a curb can cause similar twisting injuries. Older adults, individuals with weak bones, or those wearing unsupportive footwear are also at higher risk of sustaining this type of fracture during routine activities.

Ankle Fractures Are Most Common In:

• Running: Repeated pounding on hard surfaces or sudden missteps can cause stress or impact fractures in the ankle.
• Basketball: Quick jumps, pivots, and awkward landings increase the risk of rolling or twisting the ankle.
• Soccer: Rapid direction changes and contact with other players can lead to ankle instability and fractures.
• Football: High-impact tackles and abrupt movements strain the ankle joints heavily.
• Tennis: Lateral movements and sudden stops can twist the ankle, especially on uneven courts.
• Skiing: Falls or sudden foot twists inside a rigid boot can cause fractures around the ankle.

Symptoms

The most common and noticeable sign of a medial ankle fracture is pain, which typically begins immediately after the injury and can be quite severe. In addition to pain, you may experience several other symptoms, including:

• Pain that worsens with movement or activity and improves when the ankle is rested.
• Swelling and bruising around the inner or outer sides of the ankle.
• Tenderness to touch over the injured bone or the surrounding area.
• Difficulty or inability to bear weight on the affected foot.
• Visible deformity or abnormal ankle shape is a sign of more serious fractures.

These symptoms may develop quickly after injury and usually require prompt medical evaluation.

Non-operative treatment

The treatment approach for ankle fractures depends on the severity and stability of the break. Stable fractures that remain properly aligned are usually managed without surgery. Non-operative care reduces pain, minimizes swelling, and allows the bone to heal naturally.

Initial management typically includes rest and avoiding weight-bearing on the injured ankle until cleared by your doctor. Conservative treatment options may involve:

• Ice: Applying ice packs to reduce pain, inflammation, and swelling.
• Elevation: Keep the leg above heart level to decrease swelling and promote healing.
• Nonsteroidal anti-inflammatory drugs (NSAIDs): Medications such as ibuprofen or naproxen help relieve pain and reduce inflammation.
• Immobilization: Using a splint, cast, walking boot, or sturdy brace to stabilize the ankle and prevent movement during recovery.
• Physical therapy: Once healing begins, gentle exercises help restore ankle strength, flexibility, and balance.

After your doctor confirms that the fracture has healed, you can gradually return to normal activities. It’s important to follow medical guidance closely and avoid rushing recovery to prevent re-injury or long-term complications.

Try these exercises to help address your condition:

Below is a PDF of the Exercise Program

Ankle Fracture

Surgical Treatment

If the ankle fracture is unstable or out of place, surgery may be the right treatment option. In these cases, surgery can help the ankle regain its proper function and prevent arthritis from developing. During the procedure, the orthopedic surgeon realigns the broken bones and holds them together with pins/screws and plates.