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Fibula Fracture

Injuries > Lower Leg > Fibula Fracture

 

(Also known as a Fractured Fibula, Fractured Lateral Malleolus, Broken Fibula)

 

What is a fibula fracture?

A fibula fracture is a relatively common condition characterized by a break in the smaller of the long bones of the lower leg, known as the fibula (figure 1).

The lower leg comprises of 2 long bones, known as the fibula and the tibia, which are situated beside each other (figure 1). The fibula bone lies on the outer aspect of the lower leg and forms joints with the tibia (near the knee and ankle) and the talus in the ankle (figure 1).

During certain activities, such as landing from a jump, a forceful impact to the outer lower leg or ankle, or when rolling an ankle, stress is placed on the fibula bone. When this stress is traumatic and beyond what the bone can withstand a break in the fibula may occur. This condition is known as a fibula fracture.

A fibula fracture is common among the elderly, but can also occur in the younger patient. Often a fracture to the fibula occurs in combination with a sprained ankle or other fractures of the foot, ankle or lower leg (such as following trauma).

Fibula fractures can vary in location, severity and type including avulsion fracture, stress fracture, Potts' fracture, lateral malleolus fracture, displaced fracture, un-displaced fracture, greenstick, comminuted etc.


Causes of a fibula fracture

A fractured fibula commonly occurs in association with a rolled ankle particularly with significant weight bearing forces. They may also occur due to an awkward landing from a jump (particularly on uneven surfaces), due to a fall or following a direct blow to the outer lower leg or ankle. Fibula fractures are common in running and jumping sports involving change of direction such as football, soccer, rugby, basketball and netball.


Signs and symptoms of a fibula fracture

Patients with this condition typically experience a sudden onset of sharp, intense outer ankle or lower leg pain at the time of injury. This often causes the patient to limp or be unable to weight bear so as to protect the injury. Pain can occasionally settle quickly leaving patients with an ache at the site of injury that may be particularly prominent at night or first thing in the morning.

Patients with a fibula fracture may also experience swelling, bruising and pain on firmly touching the affected region of bone. Pain may also increase during certain movements of the foot, ankle or knee or when standing or walking (particularly up hills or on uneven surfaces). In severe fibula fractures (with bony displacement), an obvious deformity may be noticeable.


Diagnosis of a fibula fracture

A thorough subjective and objective examination from a physiotherapist is essential to assist with diagnosis of a fibula fracture. An X-ray is usually required to confirm diagnosis and assess the severity of the fracture. Further investigations such as an MRI, CT scan or bone scan may be required, in some cases, to assist with diagnosis and assess the severity of the injury.


Treatment for a fibula fracture

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Prognosis of a fibula fracture

Patients with a fractured fibula usually make a full recovery with appropriate management (whether surgical or conservative). Return to activity or sport can usually take place in weeks to months and should be guided by the treating physiotherapist and specialist. In patients with severe injuries involving damage to other bones, soft tissue, nerves or blood vessels, recovery time may be significantly prolonged. In patients with only very minor fractures that are un-displaced (such as an avulsion fracture) return to sport can sometimes occur in as little as 6 weeks as guided by the treating physiotherapist.


Physiotherapy for a fibula fracture

Physiotherapy treatment is vital in all patients with this condition to hasten healing and ensure an optimal outcome. Treatment may comprise:

  • soft tissue massage
  • joint mobilization
  • electrotherapy (e.g. ultrasound)
  • taping or bracing
  • the use of a protective boot
  • the use of crutches
  • ice or heat treatment
  • exercises to improve strength, flexibility and balance
  • hydrotherapy
  • education
  • activity modification
  • the use of orthotics
  • a graduated return to activity plan


Other intervention for a fibula fracture

Despite appropriate physiotherapy management, some patients with this condition do not improve adequately and may require other intervention. The treating physiotherapist or doctor can advise on the best course of management when this is the case. This may include further investigations such as X-rays, CT scan, MRI or bone scan, periods of plaster cast immobilization or referral to appropriate medical authorities who can advise on any intervention that may be appropriate to improve the fractured fibula. Occasionally, patients may require surgery to stabilize the fracture and a bone graft to aid fracture healing.


Exercises for a fibula fracture

The following exercises are commonly prescribed to patients with a fractured fibula following confirmation that the fracture has healed or that pain free mobilization can commence as directed by the surgeon. You should discuss the suitability of these exercises with your physiotherapist prior to beginning them. Generally, they should be performed 3 times daily and only provided they do not cause or increase symptoms.

Your physiotherapist can advise when it is appropriate to begin the initial exercises and eventually progress to the intermediate, advanced and other exercises. As a general rule, addition of exercises or progression to more advanced exercises should take place provided there is no increase in symptoms.


Initial Exercises

Foot and Ankle Up and Down

Move your foot and ankle up and down as far as possible and comfortable without pain (figure 2). Repeat 10 - 20 times provided there is no increase in symptoms.

Exercises for a Fibula Fracture - Foot & Ankle Up & Down

Figure 2 Foot and Ankle Up and Down (left leg)

Foot and Ankle In and Out

Move your foot and ankle in and out as far as possible and comfortable without pain (figure 3). Repeat 10 - 20 times provided there is no increase in symptoms.

Exercises for a Fibula Fracture - Foot & Ankle In & Out

Figure 3 Foot and Ankle In and Out (right leg)

Foot and Ankle Circles

Move your foot and ankle in a circle as large as possible and comfortable without pain (figure 4). Repeat 10 times in each direction provided there is no increase in symptoms.

Exercises for a Fractured Fibula - Ankle Circles

Figure 4 Foot and Ankle Circles


Intermediate Exercises

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Advanced Exercises

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Other Exercises

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Rehabilitation Protocol for a Fibula Fracture

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Physiotherapy products for a fibula fracture

Some of the most commonly recommended products by physiotherapists to hasten healing and speed recovery in patients with this condition include:

  1. Crutches
  2. Protective Boots
  3. Ankle Braces
  4. Ankle Supports
  5. Compression Bandages
  6. Ice and Heat Packs
  7. Wobble Boards (for rehabilitation)
  8. Dura Discs (for rehabilitation)
  9. Resistance Band (for strengthening)
  10. Sports Tape (for protective taping)

To purchase physiotherapy products for a fibula fracture click on one of the above links or visit the PhysioAdvisor Shop.


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Fibula Fracture Anatomy

Figure 1 Fibula Fracture Anatomy

 

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