The lateral malleolus bursa is an adventitial subcutaneous bursa that develops over the lateral malleolus of the fibula in response to chronic pressure from footwear, ankle braces, boot cuffs, or prolonged sitting with the lateral ankle contacting a hard surface. It is not present at birth and develops as a mechanical response to repeated friction.
Lateral malleolar bursitis is seen in skiers, skaters, ice hockey players, and walkers whose footwear exerts direct pressure on the lateral malleolus. It presents as a soft, fluctuant, painless or mildly tender swelling directly over the fibular malleolus, easily distinguished from peroneal tendon pathology by its superficial location. Management involves footwear modification, donut padding, aspiration, and occasionally corticosteroid injection.
Boot or shoe pressure over the lateral malleolus causes an adventitial bursa with fluctuant swelling and local tenderness, managed primarily with footwear adjustment and protective padding; needle aspiration is performed if the bursa is tense and painful.
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