Fibula Stress Fracture
(Also known as Stress Fracture of the Fibular)
What is a fibula stress fracture?
The fibula is a long bone which lies on the outer aspect of the lower leg and is responsible for transferring some weight bearing forces from the shin to the foot (figure 1). Several muscles attach to the fibula so that when they contract, they exert a pulling force on the bone. Furthermore, weight bearing activity places compressive forces through the fibula. When these forces are excessive or too repetitive and beyond what the bone can withstand, bony damage gradually occurs. This initially results in a bony stress reaction, however, with continued damage may progress to a fibula stress fracture.
Causes of a fibula stress fracture
Stress fractures of the fibula typically occur over time with excessive weight bearing activity such as running. They often present following a recent increase in activity or change in training conditions.
Signs and symptoms of a fibula stress fracture
Patients with this condition typically experience a localised pain in the outer lower leg that increases with weight bearing activity. In severe cases, walking may be enough to aggravate symptoms. Other symptoms may include night ache or pain on firmly touching the fibula.
Diagnosis of a fibula stress fracture
A thorough subjective and objective examination from a physiotherapist may be sufficient to diagnose a stress fracture of the fibula. Investigations such as an MRI, CT scan or bone scan are usually required to confirm diagnosis.
Treatment for a fibula stress fracture
Treatment for patients with this condition typically involves an initial period of rest from weight bearing activity which may include the use of crutches or a protective boot. Treatment is progressed symptomatically with rest from activity until pain settles.
Once the patient is pain-free a gradual increase in weight bearing activity and exercise can occur provided symptoms do not increase. This should occur over weeks to months with direction from a physiotherapist and will vary depending on the severity of the injury. Alternative exercises placing minimal weight bearing forces through the affected bones should be performed to maintain fitness such as swimming, cycling, and water running. Exercises to maintain flexibility, strength and balance are also important to ensure the ankle and knee are functioning correctly. The treating physiotherapist can advise which exercises are most appropriate and when they should be commenced.
Contributing factors to the development of a fibula stress fracture
There are several factors that may contribute to the development of a stress fracture of the fibula. These should be assessed and where possible corrected with direction from a physiotherapist and may include:
- poor foot mechanics
- inappropriate or excessive training or footwear
- joint stiffness
- poor flexibility
- muscle weakness
- poor balance
Physiotherapy for a fibula stress fracture
Physiotherapy treatment is essential for all patients with this condition to hasten healing, prevent recurrence and ensure an optimal outcome. Treatment may comprise:
- soft tissue massage
- joint mobilization
- electrotherapy (e.g. ultrasound)
- taping or bracing
- the use of crutches
- biomechanical correction
- exercises to improve flexibility, strength and balance
- a gradual return to activity plan.
Other intervention for a fibula stress fracture
A review with a podiatrist may be indicated for appropriate orthotics and footwear advice. Occasionally, a specialist review may be required in patients who are not progressing adequately. The treating physiotherapist can advise if either of these is required.
Exercises for a fibula stress fracture
The following exercises are commonly prescribed to patients with a fibula stress fracture. 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.
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.
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.
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.
Figure 4 – Foot and Ankle Circles
Physiotherapy products for a fibula stress fracture
Some of the most commonly recommended products by physiotherapist to hasten healing and speed recovery in patients with a fibula stress fracture include:
- Protective Boots
- Ankle Braces
- Ankle Supports
- Ice and Heat Packs
- Wobble Boards (for rehabilitation)
- Dura Discs (for rehabilitation)
- Resistance Band (for strengthening)
- Sports Tape (for protective taping)
To purchase physiotherapy products for a fibula stress fracture click on one of the above links or visit the PhysioAdvisor Shop.
Find a Physio for a fibula stress fracture
Find a Physiotherapist in your local area who can a fibula stress fracture.
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