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
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.