Educational video describing the anatomy and injuries associated with the medial ankle.
There are many structures present at the medial aspect of the ankle. These structures are often susceptible to injury.
Common injuries and conditions around the medial ankle
1-Posterior tibial tendonitis or rupture.
Posterior tibial tendon problems can occur from overuse activities, degeneration and trauma. The posterior tibial tendon is one of the major supporting structure of the foot. The tendon helps to keep the arch of the foot in its normal position. When there is insufficiency or rupture of the tendon, the arch begins to sag and a flatfoot deformity can occur with associated tight Achilles tendon. The posterior tibial tendon rupture occurs distal to the medial malleolus. This area is hypovascular. It presents with painful swelling on the posteromedial aspect of the ankle. The patient is unable to perform a single leg toe raise, too many toes, flat foot, fixed deformity of the hindfoot. Rupture of the posterior tibial tendon could be missed.
2-Tarsal tunnel syndrome
It is compression of the tibial nerve in the tarsal tunnel. The flexor retinaculum covers the nerve. Tarsal tunnel syndrome is similar to compression of the median nerve in the carpal tunnel. Causes include ganglia, accessory muscle and soft tissue mass. Differential diagnosis includes herniated disc, stress fracture and plantar fasciitis.
Clinical findings include pain on the medial side of the foot, pain worse with dorsiflexion due to tension on the nerve, paresthesia and numbness of the foot, positive tinel’s sign behind the medial malleolus. EMG is usually not helpful.
3-Flexor hallucis tendonitis
Pain, swelling, weakness posterior to the medial malleolus. Dorsiflexion of the big toe may be reduced when the ankle is placed in dorsiflexion. Triggering and pain along the tendon sheath may also occur with toe flexion. It often occurs in activities such as ballet dancing, in which plantar flexion is necessary.
4-Rupture of the deltoid ligament
The deltoid ligaments are the primary stabilizers of the ankle joint. The deltoid ligaments provide support to prevent the ankle from everting. An isolated eversion sprain with tear of the deltoid ligaments is a rare injury.

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