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Medial Malleolus Stress Fracture in a Female Basketball Player
Alison Klute, Natalie Fontela, MS, LAT, ATC, Ajaya Williams, Ed.D, MS, LAT, ATC
University of Miami
October 8, 2019
Medial Malleolus Stress Fracture in a female basketball player
A Case Report
Medial Malleolus: the process at the medial side of the inferior end of the tibia, forming the projection of the medial side of the ankle, lies superior to the lateral malleolus, attachment site for the Deltoid Ligament
Stress Fracture: a fracture caused by repeated mechanical stress such as repetitive jumping or running, are most common in the weight bearing bones of the lower leg and foot
Unionization: the healing of a fracture
A 19-year-old college basketball player from France was complaining of medial ankle pain in her left ankle during and after physical activity while playing for her team in France. She was evaluated by a doctor in France who told her to rest for 2 weeks. After the two weeks, the athlete went back to playing basketball which resulted in her being unable to walk because of the pain in her medial left ankle. Upon arriving at her college campus for the start of basketball, her athletic trainer evaluated her ankle and decided to refer to a doctor. The doctor ordered X-rays which revealed a stress fracture in the medial malleolus. The doctor decided to do surgery to unionize the fracture. Patient began post-operative rehabilitation and returned to play 14 weeks after surgery.
Medical History and Objective Findings
A 19-year-old female point guard basketball player was diagnosed with a stress reaction/fracture in France in January of 2019. Her chief compliant was pain over the medial malleolus that was worse with running and jumping. The patient has no significant past medical history and the mechanism of injury was repetitive movements from running and jumping while playing basketball. The initial treatment for the stress fracture in France was just rest. The athlete was not put in a walking boot and was not prescribed any rehabilitation. After two months of just rest the athlete was asked to play in some basketball games that would go over the course of the week. After the week of playing in basketball games the athlete could no longer walk and was put in a walking boot for two weeks. Mid-march the athlete started walking again without the walking boot. The doctors in France cleared the athlete for complete return to play on June 1st, right before she was scheduled to move down to Miami.
Once arrived in Miami the athlete came into the training room stating that her ankle had started to get swollen, bruised and hurt with walking and going up and down stairs. During the evaluation done by the athletic trainer the athlete presented with no laxity, it was observed that the ankle was stable, and that the athlete had slight swelling around the ankle but there was not much effusion. The athlete was tender to palpation around the medial malleolus and around the tibialis posterior muscle. The athlete had some pain with dorsiflexion, but had equal range of motion and strength bilaterally. The athletic trainer decided to send for an x-ray and MRI which revealed that a stress fracture was still present in the medial malleolus. The athlete then saw Dr. Steinloft who recommended surgery to put in two screws in the medial malleolus because of the lack of healing during the previous months. On July 11th, 2019, 7 months after initial pain was reported, the athlete went into surgery and got two screws put into her medial malleolus.
Differential Diagnosis are Medial Tibial Stress Syndrome, Deltoid Ligament Sprain, Tibialis Posterior Tendinitis, Tibial Stress Fracture, Tarsal Tunnel Syndrome, which can occur from the same symptoms or MOI.
X-rays confirmed a stress fracture in the medial malleolus. There were no other fractures seen on the X-ray and no torn ligaments seen on the MRI.
Medial Malleolus stress fractures are considered a high-risk stress fracture that can be seen in athletes and the general population. This case study is about a nineteen-year-old female basketball player who suffered from a medial malleolus stress fracture. She was first treated with conservative