The medial malleolus bursa is a small adventitial subcutaneous bursa overlying the prominent medial malleolus of the tibia, developing in response to chronic pressure from footwear, ankle braces, or habitual contact. It is distinct from the tarsal tunnel contents that run posterior and inferior to the malleolus.
Medial malleolar bursitis is recognised in skaters, skiers, and hikers whose boot tongue or cuff bears directly on the medial malleolus. It presents as a soft fluctuant swelling, tender to direct palpation and boot pressure. Treatment involves footwear modification, padding, and occasionally aspiration. The proximity of the great saphenous vein and saphenous nerve should be noted when aspiration or injection is performed.
Boot or shoe pressure over the medial malleolus produces an adventitial bursa with local swelling and tenderness, managed primarily by footwear modification, protective donut padding, and aspiration if the bursa is tense and symptomatic.
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