Medial malleolar bursitis is caused by the inflammation or swelling of the bursa of the medial malleolus in the ankle. This bursa is located between the skin and the medial malleolus (the flattened end of the tibia that forms the prominence of the ankle, sometimes referred to as the ankle bone). A burse is a fluid filled sac that decreases friction between two tissues.
- A direct blow to the bursa of the medial malleolus can produce inflammation and irritation.
- A fall where one lands improperly on the ankle or bursa of the medial malleolus.
- Constant pressure on the bursa of the medial malleolus from use of the ankle.
- Repeated stress injury to the bursa of the medial malleolus and tendons from a high level of activity, which can also cause tendonitis in addition to bursitis.
- Complications from rheumatoid arthritis, osteoarthritis or gout.
- Infection of the bursa of the medial malleolus or ankle.
- The bursa of the medial malleolus can become swollen as a response to other ankle conditions.
- Pain and tenderness over the location of the bursa of the medial malleolus, along the outside of the ankle at the medial malleolus bone.
- Swelling
- Loss of motion of the ankle
- Pain with activities that stress the bursa of the medial malleolus like walking, jumping, running or activities that cause stress on the tendons that are lubricated by the bursa of the medial malleolus
Avoiding the activities that produce the pain or stress the bursa of the medial malleolus is the first line of treatment.
- Avoiding activities that produce pain or stress of the bursa of the medial malleolus and associated tendons (jumping, running, etc.)
- RICE: (Rest, Ice, Compression, Elevation) should be used to reduce the stress on the bursa of the medial malleolus
- The use of ice to reduce inflammation and pain.
- NSAIDS (nonsteroidal anti-inflammatory drugs)
- Physical Therapy
- Drainage of the fluid in the bursa of the medial malleolus for severe cases. Fluid can be checked for possible infection.
- Antibiotic in the case of infections of the bursa of the medial malleolus
- Steroidal injections in non responsive cases
- Surgery to remove the bursa of the medial malleolus may be indicated in extreme cases if the problem becomes chronic.
Physical Therapists are professionals, educated and trained to administer interventions. As defined by The Guide to Physical Therapist Practice, interventions are the skilled and purposeful use of physical therapy methods and techniques to produce changes consistent with the diagnosis, prognosis and the patient or client’s goals. Physical therapy for an ankle bursitis must remain conservative at the onset in order to not aggravate the condition. Emphasis will be in rest, reducing the inflammation and increasing the blood circulation for healing. Once the initial inflammation has reduced a program of stretching and light strengthening will be initiated to restore full motion and improve strength to reduce stress on the tendons and ankle joints.
Common Physical Therapy interventions in the treatment of medial malleolus bursitis include:
- Manual Therapeutic Technique (MTT): hands on care including soft tissue massage, stretching and joint mobilization by a physical therapist to regain mobility and range of motion of the ankle. Use of mobilization techniques also help to modulate pain.
- Therapeutic Exercises (TE) including stretching and strengthening exercises to regain range of motion and strengthen muscles of the ankle to support, stabilize, and decrease the stresses place on the bursa of the medial malleolus and tendons of the ankle joint.
- Neuromuscular Reeducation (NMR) to restore stability, retrain the lower extremity and improve movement techniques and mechanics (for example, running, or jumping) of the involved lower extremity to reduce stress on the bursa of the medial malleolus and tendons in daily activities.
- Modalities including the use of ultrasound, electrical stimulation, ice, cold laser and others to decrease pain and inflammation of the bursa of the medial malleolus.
- Home program including strengthening, stretching and stabilization exercises and instructions to help the person perform daily tasks and advance to the next functional level.
Prognosis
In general, patients respond well to conservative treatment of ankle bursitis. It is important that once the pain and inflammation is reduced and motion and strength are restored that the patient gradually returns back to full activities. Instruction in daily activities or sport performance is helpful to reduce the chance of a reoccurrence of the bursitis. In most cases full return to activity will take from 2-6 weeks depending on the severity of the condition. As a preventive measure individuals should:
- Make modifications in work or daily activities and avoid positions that stress the bursa of the medial malleolus or wearing protective equipment to avoid prolonged pressure or unexpected blows on the bursa of the medial malleolus.
- Maintain strength and flexibility to reduce stress on the bursa of the medial malleolus and tendons of the ankle.
- Avoid highly repetitive activities whenever possible.
