41 yr old male presented with pain and no swelling. Xrays show apparent bony injury of medial malleolus with no soft tissue swelling. Medial malleolus ossicle is likely . It is bilateral in 25% population. General incidence though not known may be around 15% adults and more common on lateral malleolus. Case Submitted by Dr MGK Murthy.
An accessory, distal focus of epiphyseal ossification may develop in either malleolus. These foci are not anatomically separate entities, even though they appear to be radiographically. They usually are asymptomatic. However, they may be injured, either acutely or chronically. The diagnosis of such injury by conventional radiography is limited. Bone scintigraphy may be positive if there is a stress fracture.
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