An osseous fragment at the distal tip of the medial malleolus in a skeletally immature individual may represent a secondary ossification center and should not always be interpreted as a fracture. In this case study of a young dance student presenting with bilateral medial ankle pain, we postulated that hindfoot valgus, in combination with extreme loads placed on the foot during ballet training, increased stresses at the medial malleolus and accessory physis. Our patient was treated conservatively for symptomatic secondary ossification of medial malleolus and she returned to dance class at 6 months.