The medial malleolus is the bony structure located on the inner side of your ankle, forming the end of the tibia (shinbone). This structure serves as an attachment point for the strong deltoid ligament complex and acts as a pulley for tendons that support the foot’s arch. Pain in this area is a frequent concern, arising from sudden, traumatic injuries or conditions that develop slowly over many years. Understanding the distinction between these causes is the first step toward finding appropriate relief.
Common Acute Injuries
Sudden, intense pain in the medial malleolus area often indicates an acute injury involving the bone or stabilizing ligaments. While less common than sprains on the outer ankle, a medial ankle sprain involves injury to the deltoid ligament complex. This ligament resists the foot rolling outward, meaning the injury mechanism is typically a forceful eversion of the foot. A sprain usually requires a high-energy force and can involve swelling and bruising along the inner ankle.
A fracture of the medial malleolus results in a break or crack in the bone. This injury is characterized by severe, immediate pain, rapid swelling, and often the inability to bear weight on the affected foot. The fracture can occur when the foot is forcefully rolled inward or outward, either pulling a piece of bone off (avulsion fracture) or breaking the bone from compression or rotational stress. Immediate medical attention is necessary to determine if the ankle joint’s stability has been compromised.
Chronic and Overuse Conditions
Pain that begins and worsens over weeks or months is related to chronic strain or degenerative conditions affecting the soft tissues. A frequent cause of inner ankle pain is Posterior Tibial Tendon Dysfunction (PTTD), which involves the tendon running behind the medial malleolus that supports the arch. Overuse, obesity, or a flatter foot structure can cause this tendon to become inflamed (tendinitis) or progressively tear. The pain is usually felt near or below the bony prominence and is often worse during weight-bearing activities or standing after prolonged rest.
If the pain is accompanied by a burning, tingling, or shooting sensation, the issue may be Tarsal Tunnel Syndrome. This condition is caused by the compression of the posterior tibial nerve as it passes through the tarsal tunnel, located behind the medial malleolus. The pain often radiates into the arch and sole of the foot and is sometimes aggravated by prolonged standing or walking. Inflammation, a bone spur, or an abnormal foot structure can reduce the space in the tunnel, placing pressure on the tibial nerve.
Immediate Steps for Relief
For medial malleolus pain, self-care steps can help manage symptoms and prevent further irritation before a diagnosis is made. The R.I.C.E. protocol provides a framework for home treatment. Begin by resting the ankle, avoiding activities that cause pain and limiting weight-bearing.
- Applying ice to the painful area for 15 to 20 minutes several times a day can help reduce swelling and numb the pain.
- Compression with an elastic bandage should be used to gently minimize swelling, ensuring the wrap is snug but not so tight that it causes numbness or increased pain.
- Elevating the foot above the level of the heart uses gravity to help drain excess fluid, which is effective in the first 48 hours following an injury.
Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may also be taken temporarily to decrease inflammation and manage discomfort.
When Professional Medical Care is Necessary
While many strains and inflammation respond well to home care, severe symptoms warrant an immediate visit to a healthcare provider. If you experience an inability to bear weight on the foot, notice a visible deformity, or have numbness or a cool sensation in the toes, seek medical attention right away. These signs can indicate a severe injury, such as a fracture or a complete tendon tear, which requires intervention.
Medical evaluation is recommended if the pain fails to improve after 48 hours of home care, or if the swelling persists. A medical professional will perform a physical examination to check for localized tenderness and joint stability, and they may order imaging tests. An X-ray is used to rule out fractures of the medial malleolus, while an ultrasound or MRI may be used to visualize the condition of the ligaments and tendons, such as the posterior tibial tendon. Treatment may involve prescription bracing, custom orthotics to correct foot mechanics, or a referral to a specialist for advanced procedures.