Lateral Malleolus – Anatomy, Function and Injuries
The lateral malleolus is the bony prominence on the outer side of the ankle, formed by the lower end of the fibula. It stabilizes the ankle joint and is a common site of injury.
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The lateral malleolus is the bony prominence on the outer side of the ankle, formed by the lower end of the fibula. It stabilizes the ankle joint and is a common site of injury.
Definition and Anatomy
The lateral malleolus is the bony projection located on the outer (lateral) side of the ankle joint. It is formed by the distal (lower) end of the fibula (calf bone) and forms a key component of the so-called ankle mortise. Together with the medial malleolus (formed by the tibia) and the distal tibiofibular syndesmosis, it creates a stable socket that articulates with the talus (ankle bone) to form the upper ankle joint (talocrural joint).
The lateral malleolus extends slightly further downward than the medial malleolus and is positioned slightly more posteriorly. This anatomical arrangement has important implications for ankle biomechanics and injury patterns.
Function
The lateral malleolus serves several essential functions:
- It forms the lateral wall of the ankle mortise, preventing excessive lateral displacement of the talus.
- It serves as the attachment point for key lateral ligaments, including the anterior talofibular ligament (ATFL), the calcaneofibular ligament (CFL), and the posterior talofibular ligament (PTFL).
- It contributes to the overall stability of the ankle during weight-bearing, walking, and athletic activity.
Common Injuries
Lateral Malleolus Fracture
Fractures of the lateral malleolus are among the most common bone fractures encountered in clinical practice. They typically result from twisting or rolling injuries of the ankle. The widely used Weber classification categorizes these fractures based on their relationship to the syndesmosis:
- Weber A: Fracture below the syndesmosis – usually stable, often treated conservatively.
- Weber B: Fracture at the level of the syndesmosis – stability varies, may require surgery.
- Weber C: Fracture above the syndesmosis – generally unstable, surgical fixation usually required.
Lateral Ligament Injuries
Lateral ligament sprains are even more common than fractures. A supination (inversion) injury – where the foot rolls inward – is the most frequent ankle injury and typically affects the anterior talofibular ligament. Symptoms include pain, swelling, and tenderness directly over the lateral malleolus and surrounding area.
Symptoms of Injury
- Pain directly over or around the lateral malleolus
- Swelling and bruising (ecchymosis) around the ankle
- Reduced range of motion in the ankle joint
- Feeling of instability or giving way when walking
- Point tenderness on palpation of the lateral malleolus
Diagnosis
Diagnosis begins with a thorough clinical examination, including palpation of the lateral malleolus and stability testing of the ligaments. Imaging modalities used include:
- X-ray of the ankle in at least two planes (standard first-line investigation for suspected fractures)
- Ultrasound for assessment of ligament injuries
- MRI (Magnetic Resonance Imaging) for complex injuries or when clinical findings are unclear
The Ottawa Ankle Rules are a validated clinical decision tool that helps determine when imaging is necessary after an ankle injury, reducing unnecessary X-rays.
Treatment
Conservative Treatment
Stable fractures and ligament sprains can often be managed conservatively with:
- Immobilization using an orthosis (brace) or cast
- RICE protocol: Rest, Ice, Compression, Elevation
- Physiotherapy to restore strength, proprioception, and range of motion
- Pain management with anti-inflammatory medications (e.g., ibuprofen)
Surgical Treatment
Unstable fractures (e.g., Weber B with instability, Weber C) typically require surgical fixation. The procedure involves stabilizing the bone fragments using screws, plates, or wires (open reduction and internal fixation, ORIF). In cases of severe ligament tears, ligament repair or reconstruction may also be necessary.
References
- Rüedi, T.P., Buckley, R.E., Moran, C.G. (Eds.) – AO Principles of Fracture Management, 2nd Edition, Thieme, 2007.
- Weber, B.G. – Die Verletzungen des oberen Sprunggelenkes (Injuries of the Upper Ankle Joint), Hans Huber Verlag, Bern, 1972.
- Stufkens, S.A. et al. – Long-term outcome after 1822 operatively treated ankle fractures: A systematic review of the literature. Injury, 2011; 42(2): 119–127. PubMed PMID: 20855075.
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