Medial Mnkle Sprains

Last updated: February 8, 2026Reviewed date: February 8, 2026Reading time: 3 min read
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Medial ankle sprains are usually caused by a sudden twisting, turning, or rolling inwards of the ankle. A medial ankle sprain can occur due to a fall or stepping awkwardly onto an uneven surface. It can also happen due to the wear and tear of the deltoid ligament. Other Names Deltoid Sprain Medial Ligament Sprain Medial Ankle Complex Sprain Deltoid Ligament Injury Causes General Medial ankle...

Key Takeaways

  • This article explains Other Names in simple medical language.
  • This article explains Causes in simple medical language.
  • This article explains Risk Factors in simple medical language.
  • This article explains Symptoms in simple medical language.
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Medial ankle sprains are usually caused by a sudden twisting, turning, or rolling inwards of the ankle. A medial ankle sprain can occur due to a fall or stepping awkwardly onto an uneven surface. It can also happen due to the wear and tear of the deltoid ligament.

Other Names

  • Deltoid Sprain
  • Medial Ligament Sprain
  • Medial Ankle Complex Sprain
  • Deltoid Ligament Injury

Causes

  • General
    • Medial ankle sprains are poorly described in the literature
    • Isolated injury is unusual but does happen
    • Involves excessive pronation, external rotation and/or abduction
  • General
    • Mechanism typically involves eversion (pronation) of the ankle
    • Occurs while running and jumping
    • Can also occur when someone steps on outside of a planted foot or ankle giving a medially directed force
    • Other causes include landing on uneven surfaces, misstepping on stairs
Anatomic illustration of the deltoid ligament and other medial ligaments of the foot and ankle
  • Distal Fibula Fracture
  • Bimalleolar Fracture
  • Maisonneuve Fracture
  • Ankle pain and stiffness. সহজ বাংলা: বয়স/ক্ষয়ের কারণে জয়েন্টের ব্যথা।" data-rx-term="osteoarthritis" data-rx-definition="Osteoarthritis is wear-and-tear joint disease causing pain and stiffness. সহজ বাংলা: বয়স/ক্ষয়ের কারণে জয়েন্টের ব্যথা।">Osteoarthritis
  • Syndesmotic Sprain
  • Osteochondral Defect
  • Lateral Ankle Sprain
  • Ankle Joint
    • Synovial hinge joint
    • Formed by articulation formed by the distal Fibula, distal Tibia and Talus
  • Deltoid Ligament
    • Stabilizes the medial ankle

Risk Factors

  • General
    • Male Gender[3]
    • High competition levels
    • Younger athlete
  • Orthopedic history
    • Previous ankle sprain
  • Sports
    • Football
    • Basketball
    • Long Jumping
    • Rugby
    • Soccer
  • Biomechanical
    • Pes Planus
    • Dysfunction of the spring ligament
    • Posterior Tibialis Tendon Dysfunction
    • Extreme fatigue of peroneus longs muscle
  • Fractures & Dislocations
    • Distal Tibia Fracture
    • Distal Fibular Fracture
    • Talus Fracture
    • Calcaneus Fracture
    • Subtalar Dislocation
    • Ankle Fracture (& Dislocation)
    • Peroneal Subluxation
  • Muscle and Tendon Injuries
    • Peroneal Tendon Injuries
    • Achilles Tendonitis
    • Achilles Tendon Rupture
    • Posterior Tibial Tendon Dysfunction
    • Flexor Hallucis Longus Tendinopathy
  • Ligament Injuries
    • Lateral Ankle Sprain
    • Medial Ankle Sprain
    • Syndesmotic Sprain
    • Chronic Ankle Instability
    • Intersection Syndrome Foot
  • Bursopathies
    • Retrocalcaneal Bursitis
  • Nerve Injuries
    • Peroneal Nerve Injury
    • Tarsal Tunnel Syndrome
  • Arthropathies
    • Osteoarthritis of the Ankle
    • Osteochondral Defect Talus
  • Pediatrics
    • Fifth Metatarsal Apophysitis (Iselin’s Disease)
    • Calcaneal Apophysitis (Sever’s Disease)
  • Other
    • Haglunds Deformity
    • Posterior Ankle Impingement Syndrome
    • Sinus Tarsi Syndrome

Symptoms

Clinical demonstration of the external rotation stress test[4]
  • History
    • Pain over medial ankle following an acute injury (eversion or pronation)
    • Worse with ambulation, running, jumping
    • Sensation of instability
  • Physical Exam: Physical Exam Ankle
    • Useful to follow Ottawa Ankle Rules
    • There may be bruising, swelling
    • Exaggerated valgus hindfoot with or without weight bearing
    • Tender to palpation over medial malleolus
  • Special Tests
    • External Rotation Stress Test: With the foot at 90°, apply external rotation to the joint
    • Abduction Stress Test:
    • Eversion Test:
    • Anterior Drawer Test Ankle: translate distal tibia posteriorly to evaluate for laxity

Diagnosis

Radiographs

  • Standard Radiographs Ankle
  • Findings (stable)
    • Typically normal
  • Findings (unstable)
    • If complete, avulsion injury off of medial malleolus
    • Widening on the medial clear space
    • Lateral shift of talus
  • Ottawa Ankle Rules
    • Decision making rule can help determine if xray is necessary
    • They are close to 100% sensitive (need citation)
  • Consider Stress Radiographs Ankle
    • Useful in acute injuries, not chronic
    • Manual stress
    • Gravity stress views may be just as good as manual[5][6]

Ultrasound

  • Can be used to evaluate deltoid ligament
  • Chen et al: useful to distinguish isolated lateral malleolus fracture from bimal equivalent[7]

MRI

  • Can be used to distinguish partial vs complete tear
  • Evaluate for other soft tissue injuries

Arthroscopy

  • Not considered part of a diagnostic workup

Classification

  • Grade I (mild)
    • Injury: ligament fiber stretch without macroscopic rupture
    • Clinically minor swelling, palpatory tenderness
    • Hardly any functional loss
    • No increased instability
  • Grade II (moderate)
    • Injury: partial ligament tear
    • Moderate pain, swelling and palpatory tenderness
    • Mild to moderate instability
    • Moderate functional disability
  • Grade III (severe)
    • Injury: complete tear of the ligament and joint capsule rupture
    • Severe bruising, swelling, and pain
    • Significant loss of function and an increased instability
    • Unable to bear weight and walk normal

Treatment

Nonoperative

  • Indications
    • Most cases
  • In general, management mirrors Lateral Ankle Sprain
  • Cessation of physical activity
  • PRICE Therapy
  • Tall Walking Boot
    • Advance weight bearing as tolerated
  • Physical Therapy

Operative

  • Indications
    • Complete deltoid tear (grade III, possibly grade II)
    • Bimalleolar equivalent
  • Technique
    • Primary repair
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