Clinical Features, Investigation and Treatment of Tibial Nerve:

images 22 Stress fracture of the medial malleolus is an unusual injury but should be considered in the runner presenting with persistent medial ankle pain aggravated by activity. Although the fracture line is frequently vertical from the junction of the tibial plafond and the medial malleolus, it may arch obliquely from the junction to the distal tibial metaphysis.

Clinical Features

  • Athletes classically present with medial ankle pain that progressively increases with running and jumping activities.
  • Often they experience an acute episode, which leads to their seeking medical attention.
  • Examination reveals tenderness overlying the medial malleolus frequently in conjunction with an ankle effusion.


  • In the early stages, X-rays may be normal, but with time a linear area of hyperlucency may be apparent, progressing to a lytic area and fracture line.
  • If the X-ray is normal, a radioisotopic bone scan, CT or MRI will be required to demonstrate the fracture.


  • If no fracture or an undisplaced fracture is evident on X-ray, treatment requires weight-bearing rest with an air-cast brace until local tenderness resolves, a period of approximately six weeks.
  • If, however, a displaced fracture or a fracture that has progressed to non-union is present, surgery with internal fixation is required.
  • Following fracture healing, the practitioner should assess biomechanics and footwear. A graduated return to activity is required.
Stress bone injuries of the inside malleolus generally happen over time with extreme standing and walking action such as running. Physical rehabilitation treatment is essential for all sufferers with a stress crack of the inside malleolus to speed up treatment, avoid repeat and make sure an maximum result. At Alliance Rehab & Physical Therapy we provide 24/7 access to online appointments, with most of the requests scheduled in less than 48 hours. For Best Rehabilitation and Physical Therapy Call now at:  703-750-1204