Treatment of Medial Malleolar Stress Fractures

The incidence of medial malleolar stress fractures varies from 0.6%-4.1% of all stress fractures. These fractures occur almost entirely in athletes and runners, and more frequently in skeletally mature patients aged 20-40 years. Treatment depends on the result of diagnostic imaging, displacement of the fracture, and demands of the athlete. An aggressive nonoperative protocol of non–weight-bearing cast immobilization (usually for 6 weeks) may be successful if the stress fracture is diagnosed soon after symptoms appear, but time to complete healing and safe return to activity may be as long as 6 months, which is unacceptable for most elite athletes. We recommend surgical treatment of most stress fractures of the medial malleolus, especially for displaced fractures in elite athletes, leading to early recovery and early return to sports activities.