Stress fracture of the medial malleolus

We studied eight patients who had a stress fracture of the medial malleolus. The main symptom was localized pain on the medial side of the ankle. The initial radiographs revealed the lesion for only three patients; for the other patients, the diagnosis was made with the use of isotope scans and was confirmed with computerized tomography scans, magnetic resonance images, or subsequent plain radiographs. One vertical fracture was treated initially with compression with AO screws. On the basis of our experience with stress fractures in other bones, drilling was performed to enhance the formation of bone in two patients who had delayed healing and who had had symptoms for eight and twelve months. The fractures healed four and five months after the drilling. The five patients who were managed non-operatively had to avoid running and jumping for at least three months (average, four months) so that healing could take place. All five of these fractures healed within five months.