Stress fractures of the medial malleolus and distal fibula.

Stress fractures of the medial malleolus and distal fibula are rarely encountered. They typically affect the athletic and running population and manifest the usual signs and symptoms of stress fractures. Axial and torsional forces, muscular contractions, and alignment are believed to play a role in their development. Plain radiographs are often initially nondiagnostic. The diagnosis can be confirmed with radionuclide bone scanning or MRI. Most injuries are amenable to nonsurgical management. An operative intervention for athletes with medial malleolar stress fractures has been advocated under certain circumstances.