Lateral medial malleoli

Specific risks

The lateral and medial malleoli are at risk from direct pressure, shear, friction, or heat. Environmental risks can include:

  • orthoses on lower limbs
  • ill-fitting footwear with higher sides
  • foot placement when side lying in bed
  • if the legs are externally rotating in sitting or when supine in bed
  • gait style
  • placement of the foot in relation to the footplate hangers on the wheelchair or commode
  • tone and spasticity in sitting and/or in bed
  • oedema and ill-fitting compression stockings
  • contact with objects during transfers
  • These areas should be assessed by palpating for ‘boggy’, soft, or tender areas.

Management of breakdown

  • Review causative factors such as showering aids, footwear options, wheelchair set up and the range of movement in lower limbs.
  • Continue sitting as this area can be offloaded when sitting. Options for consideration may include:
    • footwear with lower edges around the ankles
    • custom orthoses or modifying commercial devices, as they do not accommodate malleoli offloading
    • use of pillows in bed when side lying in conjunction with protective devices if needed
    • review of feet positioning in the commode and wheelchair
    • removing compression stockings
  • Review oedema and management with a QSCIS and trained oedema therapist.
  • Link with wound care or podiatry services ongoing. Malleoli wounds can be slow to heal due to being on the lower extremities where there is impaired circulation and/or oedema.
  • Closely monitor for infection and cellulitis. Screen and treat early, if suspected.

Check out other pressure injury locations and learn how to manage them.