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# Ankle bursae

The ankle bursae are small fluid sacs over the ankle bones and under the front shin tendon; they reduce rubbing.

Official name: Subcutaneous bursa of lateral malleolus

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## What it is

Small fluid sacs under the skin over the inner and outer ankle bones, and under the [tibialis anterior tendon](https://durgical.com/en/anatomy/tendon-of-tibialis-anterior/).

## What it does

Reduce friction where skin or tendons move over bone.

## Key points

- Malleolar bursitis is a soft swelling directly over the bone, separate from the joint and the tendon sheaths: the ankle moves freely and painlessly
- The subtendinous bursa of tibialis anterior lies under the tendon close to its insertion on the medial cuneiform and [first metatarsal](https://durgical.com/en/anatomy/first/)
- In people with neuropathy, such as from diabetes, a pressure bursa over a malleolus can ulcerate and become infected

## Key facts

**Where**
Subcutaneous bursae over medial and lateral malleoli; subtendinous bursa of tibialis anterior

**Function**
Reduce friction of skin and tendons over bony points

## Relations

**Superficial**
[Skin](https://durgical.com/en/anatomy/skin/) and thin fat; the [great saphenous vein](https://durgical.com/en/anatomy/great-saphenous-vein/) and [saphenous nerve](https://durgical.com/en/anatomy/saphenous-nerve/) pass in front of the medial malleolus, the [small saphenous vein](https://durgical.com/en/anatomy/small-saphenous-vein/) and [sural nerve](https://durgical.com/en/anatomy/sural-nerve/) behind the lateral one

**Deep**
Subcutaneous surfaces of the medial and lateral malleoli; for the [tibialis anterior](https://durgical.com/en/anatomy/tibialis-anterior-muscle/) bursa, the [medial cuneiform](https://durgical.com/en/anatomy/medial-cuneiform-bone/) under the tendon

## How to find it

Both malleoli lie just under the skin. A malleolar bursa is a well-defined swelling over the bony tip that moves with the skin; tendon sheath swelling follows a tendon behind or below the malleolus, and an ankle effusion fills the front of the joint.

## On imaging

Ultrasound shows a compressible fluid collection between the skin and the malleolus, separate from the tendon sheaths and the joint. MRI is kept for swellings that look solid or atypical.

## Common problems

- Can swell from pressure, such as tight boots or sitting cross-legged.

## Clinical notes

- The differential of a lump over the malleolus includes bursitis, tenosynovitis, an ankle effusion, a ganglion and a lipoma; examination and ultrasound usually settle it
- Subcutaneous malleolar bursae are often acquired, forming over the lateral malleolus in people who sit cross-legged or on the floor and under tight boots or casts
- A red, hot, tender malleolar bursa may be septic or crystal-related (gout); aspirated fluid is sent for cell count, Gram stain, culture and crystals

## Related conditions

- [Chikungunya](https://durgical.com/en/conditions/chikungunya/)

## Test yourself

Think of the answer, then tap the question to see it.

## Which bursae make up the ankle bursae?

Subcutaneous bursae over the medial and lateral malleoli and the subtendinous bursa of the tibialis anterior.

## How does malleolar bursitis differ from an ankle effusion on examination?

It is a soft swelling directly over the bone, and the ankle moves freely and painlessly; an effusion fills the front of the joint.

## Why is a malleolar pressure bursa a concern in diabetic neuropathy?

It can ulcerate and become infected.

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Educational information, not medical advice. For any symptom, see a health professional.

## Its names

**Official Latin (TA2)**
bursa subcutanea malleoli lateralis; bursa subcutanea malleoli medialis TA2 2749

**Official Spanish (DeCS)**
Bolsas subcutáneas de los maléolos DeCS D002061

**English (TA2)**
Subcutaneous bursa of lateral malleolus

**Also called**
bursa subcutanea malleoli fibulae

## Related

- [Tibialis anterior tendon](https://durgical.com/en/anatomy/tendon-of-tibialis-anterior/)

Sources: Terminologia Anatomica (TA2); [DeCS](https://decs.bvsalud.org/es/ths/resource/?id=2094&filter=ths_termall&q=Bolsa%20Sinovial); [Anatomy, Skin Bursa](https://www.ncbi.nlm.nih.gov/books/NBK554438/).

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Representative model, for educational purposes only.

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Source: https://durgical.com/en/anatomy/subcutaneous-bursa-of-lateral-malleolus/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/anatomy/subcutaneous-bursa-of-lateral-malleolus/