Sports Medicine
Sports Injury Prevention & Rehabilitation
(650) 815-6552

Voted Best Sports Therapy Clinic in the San Francisco Bay Area 2010-2016!

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.
The lower leg comprises of two long bones, known as the fibula and the tibia, which are situated beside each other. 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.
During certain activities such as landing from a jump, 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 fibula fracture 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 volleyball.

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 physician is essential to assist with diagnosis of a fibula fracture. An X-ray is usually required to confirm diagnosis and assess the severity. 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
For those fibula fractures that are displaced, treatment typically involves anatomical reduction (i.e. re-alignment of the fracture by careful manipulation under anaesthetic) followed by surgical internal fixation to stabilize the fracture (using plates and screws). This may be followed by the use of a protective boot or crutches for a number of weeks.
For those fractures that are not displaced, treatment typically involves the use of a protective boot or crutches for a number of weeks.
Evaluation of the fracture with follow up X-rays is important to ensure the fracture is healing in an ideal position. Once healing is confirmed, rehabilitation can begin as guided by the treating physical therapist.
One of the most important components of rehabilitation following a fibula fracture is that the patient rests sufficiently from any activity that increases their pain (crutches and / or a protective boot are often required). Activities which place large amounts of stress through the fibula should also be avoided, particularly excessive weight bearing activity such as running, jumping, standing or walking excessively (especially up hills or on uneven surfaces). Rest from aggravating activities allows the healing process to take place in the absence of further damage. Once the patient can perform these activities pain free, a gradual return to these activities and weight bearing forces is indicated provided there is no increase in symptoms. This should take place over a period of weeks to months with direction from the treating physical therapist.
Ignoring symptoms or adopting a 'no pain, no gain' attitude is likely to cause further damage and may slow healing or prevent healing of the fibula fracture all together.
Patients with a fractured fibula should perform pain-free flexibility, strengthening and balance exercises as part of their rehabilitation to ensure an optimal outcome. This is particularly important, as balance, soft tissue flexibility and strength are quickly lost with inactivity. The treating physical therapist can advise which exercises are most appropriate for the patient and when they should be commenced.
In the final stages of rehabilitation, a gradual return to activity or sport can occur as guided by the treating physical therapist provided there is no increase in symptoms.

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 physical therapist 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 physical therapist.

Physical therapy for a fibula fracture
Physical therapy 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
  • exercises to improve strength, flexibility and balance
  • hydrotherapy
  • education
  • activity modification
  • a graduated return to activity plan

Other intervention for a fibula fracture
Despite appropriate physical therapy management, some patients with this condition do not improve adequately and may require other intervention. The treating physical therapist 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.