What is the indicated initial treatment for a patient with pain and swelling posterior to the medial malleolus?

The initial treatment for a patient experiencing pain and swelling posterior to the medial malleolus typically involves immobilization in a cast boot for a specified period, such as three weeks. This approach is appropriate as it provides necessary support to the affected area, reduces movement that could exacerbate the injury, and allows for healing. Immobilization helps manage pain and swelling effectively, especially in cases that may involve sprains or minor injuries to the soft tissues surrounding the ankle.

Surgery is generally reserved for more severe injuries, such as fractures or significant ligament tears, and would not be the first course of action unless there's clear evidence that surgical intervention is necessary. Physical therapy usually follows initial treatment and immobilization to aid in rehabilitation, enhancing mobility and strength. Injectable corticosteroids could be considered for more chronic or managed discomfort, typically after initial conservative treatments fail, rather than as the primary approach upon initial presentation of symptoms.