Lateral Malleolus Fracture Symptoms and Treatment

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Fractures of the lateral malleolus are the most common type of ankle fracture. These injuries typically occur when the ankle is either twisted or rolled, often with an awkward or uneven step. Most lateral malleolus fractures are considered to be stable ankle fractures and can be treated without surgery.

The lateral malleolus is the name given to the bone on the outside of the ankle joint. This bone is part of the fibula, one of two bones of the lower leg; the other leg bone is called the tibia (shin bone). The tibia carries the vast majority of the weight of the body (about 90%), with the fibula holding only about 10% of body weight.

How to Treat a Lateral Malleolus Fracture
Verywell / Cindy Chung 

Lateral Malleolus Fracture Symptoms

Lateral malleolus fractures cause pain, swelling, and bruising around the ankle. Pain in other areas of the foot and ankle should be a reason to suspect a more serious ankle injury than an isolated lateral malleolus fracture.

Pain and swelling on the inner side of the ankle (along with a lateral malleolus fracture) may indicate the possibility of an injury called bimalleolar equivalent fracture even without a second fracture. This is a specific type of unstable ankle fracture that may require surgery.


Anyone with a lateral malleolus fracture should be examined for signs of a more serious, unstable ankle fracture. The good news is that isolated lateral malleolus fractures are often stable ankle fractures and do not have this problem, although it is important to see a specialist to differentiate between the two.

An unstable ankle fracture is an injury that occurs when the fracture causes the ankle joint to not work properly. Therefore, if the bone heals in a position where the ankle is not functioning properly, the ankle is likely to develop early ankle arthritis.


Treatment of a stable lateral malleolus fracture should consist of efforts to reduce swelling followed by a gradual progression in weight-bearing.

  • Ice application: Ice application is helpful at reducing pain and minimizing swelling.
  • Elevation: Elevation is important to keep swelling limited. Be sure your ankle is above your heart. (In order to do this, you have to lie down, you can't do it sitting!).
  • Anti-inflammatory medications: Nonsteroidal anti-inflammatory medications, including Motrin (Ibuprofen) and Aleve (Naproxen), are helpful at controlling both swelling and pain.
  • Rest/immobilization: While a stable ankle fracture can support your weight, it helps to limit weight-bearing to control pain and swelling. Usually, a week or two with crutches will control these symptoms.

When progressing weight-bearing, many studies have been done to assess how much protection of the ankle is best. Some healthcare providers use walking casts, walking boots, air casts, ankle braces, or even high top shoes (hiking boots).

Studies show no difference when comparing different types of ankle support. Talk with your healthcare provider about the best option to give you support and comfort for your ankle injury.

Is Surgery Preferable?

The clear answer is that surgery is not needed for stable lateral malleolus fractures. The reason is that non-surgical treatment has been shown to be just as effective for the treatment of the broken bone

In addition, surgery has a chance of both infection and healing problems (about 2%) and these can cause significant problems. People who have had surgery for fibula fractures may develop chronic swelling around their ankles.

Lastly, when people do have metal implants around the ankle, they may choose to have the metal removed down the road. This would require a second surgical procedure when. So if surgery is not recommended, it is probably for the best.

Frequently Asked Questions

  • What is a lateral malleolus fracture?

    A lateral malleolus fracture is the most common type of ankle fracture. It involves a break of the lateral malleolus bone, the knobby bump on the outside of the ankle.

  • What are the symptoms of a lateral malleolus fracture?

    The common signs of a lateral malleolus fracture are pain and swelling, which may be isolated to the ankle itself or spread to parts of the foot or upward toward the knee. The pain will almost invariably be more intense when weight is placed on the ankle.

  • What causes a lateral malleolus fracture?

    Most fractures are caused by either a rotational injury in which the ankle is abnormally twisted or a high-impact injury resulting from a fall or blow to the ankle.

  • How is a lateral malleolus fracture diagnosed?

    A plain film X-ray is often enough to diagnose a lateral malleolus fracture. However, if there is a complex fracture or associated trauma to the joint or connective tissues, a magnetic resonance imaging (MRI) or computed tomography (CT) scan may be ordered.

  • How is a lateral malleolus fracture treated?

    It depends on the severity of the fracture. The first goal is to properly realign the bone. Certain mild fractures may be treated non-surgically with an ankle splint or short leg cast along with supportive care and pain management. Severe fractures may require surgery with internal or external fixation to help stabilize the bone as it heals.

  • How long does it take for a lateral malleolus fracture to heal?

    If surgery is needed, a lateral malleolus fracture can usually heal within four to six weeks. The first couple of weeks usually involves an ankle splint and elevation of the foot for around 90% of the day. Thereafter, the splint may be replaced with a removable boot. When X-rays show ample healing, weight-bearing exercises can be started under medical supervision.

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