The medial malleolus is the distal medial projection of the tibia forming the medial wall of the ankle mortise. It articulates with the medial talus and provides the attachment site for the deltoid ligament, the strongest ligament of the ankle. Medial malleolus fractures occur in approximately 50 percent of ankle fractures and require fixation when combined with lateral malleolus fractures or when the medial fragment is displaced.
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| Ossification | The medial malleolus ossifies from the primary tibial distal epiphysis, beginning at approximately 1 year and fusing with the tibial shaft at skeletal maturity around age 16 to 18. |
The medial clear space between the medial malleolus and the medial talus on mortise view radiographs should not exceed 4 mm. Greater widening indicates deltoid ligament insufficiency or medial malleolus fracture. Medial malleolus fractures at the base (suprasyndesmotic) are fixed with cancellous screws; tip avulsions (infrasyndesmotic) may be treated conservatively if minimally displaced. The posterior tibial tendon, FDL, and tibial nerve run posterior to the medial malleolus through the tarsal tunnel.
Feel the large bony prominence on the inner side of the ankle; this is the medial malleolus. Its tip sits higher and further forward than the tip of the lateral malleolus. The tibialis posterior tendon can be felt just behind it when the person points the foot down and in.
Occurs in rotational ankle injuries, alone or as part of bimalleolar and trimalleolar fractures.
A vertical stress fracture in running and jumping athletes, causing medial ankle pain.
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