Although tibia and fibula fractures are amongst the most common long bone fractures, it’s rare to get an isolated fibula fracture. A fibula fracture, doesn’t always require surgery. Remember that your fibula only bears 17% of your body’s weight as you walk and stand. Therefore a fibula fracture is usually classified as not as severe as thigh and tibia bone fractures. However a broken fibula closer to your ankle joint, causes serious ankle stability problems and is handled with more caution.

Our team of expert physiotherapists understand and know how to handle all the different types of fractures of the fibula. We are here to guide you step by step through your rehabilitation process and ensure that you can jump, run and play without hesitating and wondering if your fibula is 100%.

What is the structure of your fibula bone?

Your fibula bone forms part of the 2 long bones of your lower leg. Your fibula sits just below your knee joint and extends downwards to form the outer part of your ankle joint. This outer part of your ankle joint is known as your lateral malleolus and is that bony bump that you can feel on the outside part of your ankle. At the top part of your fibula bone, there’s a specific part called the fibular head, where your common peroneal nerve wraps around before dividing into deep and superficial branches. Fractures in this area are serious when the nerve gets injured.

The periosteum is a thin membrane covering you on your fibula bone. It mainly provides nourishment for the outer parts of your fibula. The periosteum is rich with nerves that can cause severe pain when the fibula is broken and the membrane is torn.

What is the function of your fibular bone?

It doesn’t hold most of the force in your leg, and only carries 17% of your body weight. Therefore it serves as an anchor for your muscles and ligaments to attach to. When the stable foundation is shattered, muscles like the hamstrings and peroneal muscles cannot work normally. More importantly the fibula is crucial for ligaments to anchor that secures the outside of your ankle. If the fibula breaks, the three ligaments namely the Lateral collateral-, Tibiofibular ligament and Tibiofibular syndesmosis tears and stability around your ankle collapses.

I fractured my fibula… How did it happen?

Stress and a blunt force over your fibula bone can easily break it. Your fibula only has a strong outer shell, with spongy bone inside. If the impact cracks the outer frame, the fibula breaks and fragments reap havoc as it tears into soft tissue.

Your fibula is even more susceptible to angular or rotational forces that twists the bone like a towel being wringed.

Different types of fibular fractures can occur depending on the manner in which you injure your leg. A stress fracture is the result of minor repetitive trauma over a long time. An avulsion fracture occurs when your ligaments pulls off the piece of bone that it was anchored onto. Direct trauma to your fibula leads to a midshaft fracture of your fibula.

Disease conditions that influence calcium, magnesium absorption lowers in your bone quality. Density of the bone is lowered by nutrition, loading and even hormones. This fracture is known as a pathological fracture, where the bone is so brittle the slightest bump cases it to shatter like glass. This type of fibula fracture requires a special treatment plan.

Causes of your fibula fracture…

Activities that cause fibula fractures:

  • Motor vehicle accidents: Direct blow to your fibula.
  • Pedestrian vehicle accidents: Direct trauma to your fibula usually inflicted by the car’s bumper.
  • Gunshot wounds: Shot in the lower leg, the bullet shatters your fibula.
  • Soccer & Kickboxing: Kicked directly on your fibula by your opponent.
  • Sports that involve quick direction changes like Rugby: Excessive rotational force to your fibula.

Risk factors increasing your chances of a fibular fracture:

  • Smoking – Nicotine and increased levels of carbon-monoxide lowers the body’s immune response to repair bone tissue.
  • Diabetes – Bone healing is slow due to uncontrolled blood glucose levels.
  • Obesity – A Couch potato’s poor circulation and not to mention the added weight and forces your leg must hold.
  • Previous falls or fractures – Poor stability from the supporting structures puts you at high risk of re-injuring your fibula.
  • Very low levels of physical activity – Poor circulation and nutrition can alter bone structure and strength, that makes it easier to break.
  • Low bone mineral density – underlying conditions can absorb more calcium from your bones making them brittle.
  • Older than 50 years of age – Bone density peaks in your 30s, and gradually declines throughout your life, in some patients this process is accelerated triggered by hormonal changes, especially in females. Even a greater risk after menopause without hormone replacement therapy.
  • After menopausal bone loss – hormonal changes triggers faster absorption of Calcium due to lack of estrogen that is an essential ingredient to create osteoclasts (bone forming cells)
  • Repetitive high levels of activity can lead to a load to high for your fibula to tolerate resulting in a stress fracture or a hairline fracture.

Symptoms if your fibula is broken

Your pain is one of the first signs of a fibula fracture. Swelling and bruising is obvious due to tearing of the blood vessels inside your bone. Blood cells then escape from your broken bone, the bone marrow leaks out into the area causing swelling under your skin.

Tests that you can do to see if you might have a fibula fracture

  • Sit upright on a chair.
  • Slowly cross your painful leg over your uninjured leg.
  • Then bend your painful knee to 90 degrees.
  • Lastly slide your injured leg across so that your injured leg’s ankle is now resting on your knee.
  • The test is positive if you feel pain and clicking on your fibula at any point during these movements.
  • You may have a fibula fractue.
  • Stand sideways with your injured leg facing the wall. (Stand comfortably with your feet slightly apart and arms hanging next to your sides)
  • Slowly twist your injured leg’s ankle outward into the wall.
  • Repeat this movement on your uninjured leg and compare.
  • The test is positive if you feel pain, weakness or clicking of your injured leg at any point during this movement.
  • You may have a fibula fracture.
  • Ask a friend to sit on a chair that can swivel to the left and the right, like an office chair.
  • Stand comfortably behind the chair holding onto the chair’s backrest for balance.
  • Still holding onto the chair now shift all your weight onto the injured leg and stand only on this leg.
  • Turn your hips as far as you can by rotating your friend on the chair to the left and right.
  • Repeat this movement 10 times in 20 seconds.
  • Ensure that you twist as far as possible to each side.
  • The test is positive if you feel pain or weakness of your injured leg and limited range of movement on one side.
  • This may indicate a possible fibula fracture.

How serious is my Fibula fracture ?

Treatment of your fibula fracture is based on your the alignment of your broken bones and the stability of your ankle and knee joint. When fragments close to your knee and ankle breaks seriously derails the joint movement by disrupting forces transferred through the joints. A broken fibula closer to your ankle is more unstable, but there’s a higher risk of nerve injury closer to your knee. This is things to consider when determining how severe your fibula fracture is.

Constant unrelenting pain with or without movement is a serious problem, especially when it doesn’t ease with pain medication. Even worse sign of regression is pain spreading up and down over a larger area.

Swelling (thick) is one thing, but, blue bruising visible under your skin is more severe, because of rupture of important blood vessels in the area. When circulation is cut off from oxygen and nutrients, its harder for healing cells to get to the injured site. Excessive swelling also puts pressure on the surrounding tissue that further limits good blood flow.

We get it, any fibula fracture is quite painful, but when you move less – to avoid the pain, you may be limiting your recovery even more. There is a safe spectrum that you should be able to move to encourage circulation, without making the fracture worse. Stiffness of the ankle and knee after a few weeks becomes a bigger problem than the original fracture itself. Not to mention cardio-vascular deterioration.

Generally a simple fracture of the middle part of your fibula doesn’t require any surgery, but tends to develop secondary complications. Sometimes the broken fibula fragments pierce into surrounding muscle or through your skin, surgery is necessary.

Even with closed fibula fractures, bone pieces can sever nerves running to your foot. This is a medical emergency and has a limited time to re-connect the cut nerve ends. When a nerve is involved in a fracture, it takes the highest priority. Nerve damage is serious and usually causes Pins and needles, numbness and weakness over your lower leg and foot.


Physiotherapy diagnosis for a fibula fracture

Our physiotherapists are experts when it comes to the structure of your fibula fracture and experienced in the type of injuries that can lead to a broken lower leg. We have years of experience to test, diagnose and treat a fractured bone. When we suspect you have a broken fibula, we will refer you to get a X-ray and confirm the size, shape and stability of the fracture.

If you don’t have a broken fibula we can identify the root cause of your lower leg pain by testing other structures like joints, muscles, ligaments and nerves in the area and provide you with an accurate diagnosis. That’s why our physiotherapists are the best equipped to manage your leg injury.


X-rays are the best investigation to diagnose a fibula fracture. X-rays shows the integrity and alignment of your bones.

With a X-ray we can determine the site, type and alignment of your broken fibula. Even larger cracks can be picked up by a skilled radiologist. If your specific fibula fracture would require surgery, our team of physios are well connected with various specialists and can refer you to the most appropriate surgeon.

Diagnostic ultrasound

A Sonar is not the first choice of imaging when confirming a broken fibula bone. However, bone gapping, callus formation and severe bone swelling can be signs that we look for to assume there might be a fracture. Sometimes avulsion fractures are first picked up on sonar, that’s usually followed by an X-ray.

Furthermore ultrasound identifies bleeding, ruptured ligaments and muscles around your injured fibula. If you need an ultrasound, your physio can refer you.


Why is the pain not going away?

When you break your fibula, the initial pain that you feel in and around your leg is normal. This is your body’s way of warning you that you are loading your broken leg too early. It reminds you that your broken leg still needs to heal and thus you can see the pain as a protective mechanism. There is a risk of more critical and possibly irreversible damage if you don’t take the warning signs seriously.

The opposite is also true, if you are too scared to start loading your healing fibula when necessary, chronic pain and other complications will develop.

If you complete the correct treatment protocol, your pain should gradually decrease. However, if you neglect to work through your rehabilitation process and don’t get the right treatment from the start, you’ll continue to feel pain. With time, it bothers you more and more, it will prevent you from using your leg properly and your ankle and knee pain get worse, more weak and stiff. You become stuck in a cycle of pain, not knowing if it is better to respect pain or push through pain.

It is crucial to ensure that you are getting the right treatment for your broken fibula from the start.
This includes getting an accurate diagnosis, the right medical treatment and working through a personalized rehabilitation program. Our rehabilitation program ensures that you can return to walking, running, jumping and even competitive sport.

What NOT to do

  • Leave your broken fibula untreated

  • Managing your leg pain by only taking pain medication or muscle relaxants for more than 2 weeks.

  • Not respecting your pain and pushing through pain

  • Continuous use of anti-inflammatory medication.

  • Not keeping to the treatment guidelines.

  • Taking weight on your injured leg too soon or removing your moon boot.

What you SHOULD do

  • Rest, elevate and offload your leg as instructed

  • Avoid activities that flare up your pain, like running on an uneven surface

  • Make an appointment to confirm your diagnosis and determine how severe your injury is.

  • Take your pain medication as prescribed so that your pain is well controlled.

  • Rest as needed

Making it worse

  • Running too early in your rehabilitation process

  • Excessive jumping in the early phase of your rehabilitation program

  • Wearing high heels

  • Returning to strenuous sports like rugby, soccer or netball without being cleared by your physiotherapist

  • Sitting with the injured foot hanging for prolonged periods

  • Walking without your brace or moonboot while your fracture is still healing.

  • Walking long distances on the beach while your leg is still weak

  • Continuous wearing your moonboot/ankle brace after the physiotherapist instructed you to stop using a brace

Problems we see when patients come to us with a fibula fracture…

Common mistakes patients make when it comes to their healing proses after an injury are…

Self diagnosing and not consulting a medical professional to accurately diagnose your injury. This can delay your healing time and cause more damage to your already injured leg. Especially with a broken fibula, you will need guidance from a physiotherapist as to what type of  fracture you sustained and when you can safely return to activity.

Patients wait too long to consult a physiotherapist, because they think their pain will resolve on its own. The problem with leaving your broken fibula without treatment for too long is that many secondary complications develop; like a painful knee and ankle joint or blood clots that can form in your calf.

Not completing your treatment plan is a very common problem that we see in our practice. You might think that your leg is healed when you don’t experience any pain and can return to your normal daily activities without pain. Unfortunately, this is not the case. You can reinjure your leg very easily when doing an odd and new activity. For example taking a jog on the beach during your long awaited holiday. The reason for this reinjury is that even though your leg is now pain free, it is not yet optimally strong and is specifically lacking balance and stability. Balance and stability needs to be retrained and is usually done at the end stage of your treatment process.

Wearing a brace and the use of crutches greatly assist your injured leg by decreasing the load on your fibula. But, these aids should only be used for a specific time frame or are sometimes not even required at all. A few functional goals need to be achieved first before your physiotherapist will start guiding you away from using a brace and crutches. Using these walking aids for too long can actually weaken your leg and delay your healing.

Physiotherapy treatment

Our team of skilled physiotherapists follow specific treatment guidelines to help you heal from your fibula fracture in the shortest time possible while being safe and limiting complication that tends to develop after a fibula fracture. We are confident that we can provide you with the best possible treatment for your broken fibula.

Patients are often not well informed regarding their specific injury and are scared that they are doing too much or too little during their rehabilitation period. That is why we are here to provide guidance and answers throughout your healing journey to address your fears. We understand the various treatment protocols for each type of fibula fracture. We’ll give you relevant and clear advise that is most useful for you. A personalized treatment program for your specific fracture and get you back to running again.

We’ll develop and implement a tailor made treatment program for you, that treats all the aspects of your injury. This way your pain, muscle strength, flexibility and endurance will improve and you’ll be able to return to your favorite activity with confidence again. However, it’s important that you complete your rehabilitation plan, as this guarantees a full recovery and decreases your risk of reinjury.

Our physiotherapists uses these techniques during your treatment:

Compression bandaging and applying ice will decrease swelling and promote blood flow through your site of injury. Crutches decreases the weight that your fractured fibula needs to carry for the first few weeks, which enables your leg to rest.

We use Ultrasound and Laser machines to decrease your pain and speed up your healing process.

Joint mobilization techniques move all your surrounding joints and Myofascial release of your lower limb muscles limit excessive scar tissue formation and compensatory patterns from forming.

Gradual loading of your fractured leg, conditions your leg to handle weight once more. Eccentric loading, followed by plyometric exercises condition your muscle fibers. We will gradually progress your rehabilitation exercises so that you can regain full function of your lower limb.

Phases of rehabilitation

Right after you fracture your fibula, your body sends out signals to start bone healing. These signals cause cellular and chemical reactions. You can imagine the process like a production line in a workshop full of specialists, where each one has a specific role. Bone healing is a four-step process consisting of inflammation, repair, new bone formation, and bone remodeling.

You need physiotherapy treatment twice a week for the first 2 weeks after your fracture. After these initial 2 weeks, your treatment sessions is spaced out to 1 session a week for the next 12 weeks. We’ll reassess as you progress through the phases.

1st Phase: Bone Healing (0-1 week)

Hematoma formation (days 1 to 5 after fracture). This stage begins immediately following your fracture and starts the healing process of your broken bone. Fibrocartilaginous callus formation (days 5 to 11 after fracture). This stage involves the forming of new bone cells to mend your fracture site. It is crucial to ensure good immobilization of your leg by means of a cast, brace or moon boot to limit excessive movement of your broken bone. Limiting the amount of weight on your broken leg, is important to ensure no shifting of your fractured bones.

Another aim of this phase is to keep you safe, while staying active. We

Laser and ultrasound are applied to your injured area to increase your rate of healing. Ice, elevation and circulatory exercises helps to decrease your pain and swelling. Strapping and Taping is used to support and protect your injured leg from further injury.

At the end of this phase you must walk and climb stairs with crutches taking 10% weight on your fractured fibula.

2nd Phase: Pain free range of motion – Period: (2-6 weeks)

Promote good bone healing and union. Move your knee and ankle through full range. Strengthen your affected leg in preparation for walking. Dry Needling of your surrounding muscles, is used to ensure smooth pain free movement of your leg. We Massage and use Soft tissue mobilization techniques of all your affected muscles to decrease muscle spasm.

We will use massage, TENS, laser therapy and joint mobilization techniques to decrease your swelling and pain. Neural interface release, strengthening exercises for your surrounding muscles and Isometric exercises are used to build the necessary support for your fractured leg.

  • This Benchmark you must walk with crutches and take full weight. When you walk with crutches you must feel minimal pain.

3rd Phase: Fusion Phase – Period: (6-8 weeks)

  • Aim of this phase:

Bone remodeling (day 18 after fracture onwards, lasting months to years). 6 Weeks after your fibula fracture, no fracture line should be seen on a x-ray. A white bump like formation can be seen at your fracture site uniting your 2 broken bones. This “bump of bone” will gradually remodel and become smaller, after a few months no bump will be seen and your bone would look the same as before your fracture took place.

Evaluate to see if your fibula bone and lower limb muscles are able to handle tensile, elastic and compression forces. Gradually increase the load required on your leg to condition your joints and surrounding muscles. Ensure that you regain confidence in your leg’s functional ability.

  • Physiotherapy treatment techniques:

Gradually we will increase the loading of your affected leg and ensure independent walking with full weight-bearing. Soft tissue release of your surrounding muscles and ligaments, as well as joint mobilization techniques are used to help your leg deal with the increased load of this phase. Corrective taping and bracing of your joint and muscles as support. Finally, there will be concentric strengthening exercises and proprioceptive and balance retraining.

  • You should be able to balance on your affected leg for 10 seconds, and walk pain free .

4th Phase: Stress Phase Period: (8-10 weeks)

  • Aim of this phase:

To optimally strengthen your leg to your specific daily functional demands. Ensure that your leg can handle an increased load for an extended time period, without failing.

  • Physiotherapy treatment techniques:

After gradually increasing the load of your affected leg we will start to increase the amount/repetitions of the prescribed exercises. We will continue with soft tissue release of your surrounding muscles and ligaments, joint mobilization techniques and might use Electrotherapy (laser, EMG, Russian stimulations) to support the hands-on treatments. Corrective taping and bracing of your joints and muscles can be used to support your leg. Dry needling manages the muscle pain you are feeling. Concentric and eccentric strengthening exercises go along with proprioceptive and balance retraining.

  • Enurance: walk 1 kilometer,
  • Bone strength:

At the end of this phase, you should be able to walk 1 kilometer, climb an entire flight of stairs (with alternating legs) and balance on your affected leg alone for 60 seconds, without losing your balance, feeling pain or limping.

5th Phase: Jump phase – Period: (10-12 weeks)

  • Aim of this phase:

Optimize your leg’s stability and balance to avoid future injuries. Restore your leg’s strength when coming to jumping activities.

  • Physiotherapy treatment techniques:

We will prescribe a specific exercise program to improve your leg’s stability and balance. The use of Kinesio tape will facilitate your leg coordination and rigid strapping can be used to brace or offload your leg. Laser therapy is used to increase the rate of healing. Soft tissue release of your surrounding muscles and ligaments encourages free movement and gets paired with joint mobilization techniques.

  • Functional goals you should achieve in this phase:

At the end of this phase, you should be able to balance for 1 minute on your injured leg, while standing on a trampoline with your eyes closed. You should also be able to run 1 km at an easy pace, and jump & land on your injured leg with no pain or limping. Every jump on your injured leg should be as easy as it is to jump on your uninjured leg.

6th Phase return to sporting activities. Period: (3 months-5 months)

  • Aim of this phase:

Gradually condition your leg to meet all the requirements of your specific sporting discipline. Ensure that you are ready to return to sport training and matches. Minimize the chances of you reinjuring your leg.

  • Physiotherapy treatment techniques:

We will provide endurance and fitness drills as well as sport-specific exercises depending on the sport you partake in. We make use of corrective and assisted taping techniques to support your leg and use muscle activation techniques to encourage your muscle movement. Laser therapy is used to support hands-on therapy and psychotherapy ensures your confidence, in your newly healed leg. Yes! You can return to your sport.

  • Functional goals you should achieve in this phase:

At the end of the final phase, you should be able to balance for 5 minutes on your injured leg while standing on a trampoline and throwing a ball against a wall. You should be able to jump forwards, backward and sideways over a hurdle on your previously injured leg. When you run on grass you should be able to pivot and change direction quickly to catch a ball without incident, injury or pain.

Healing time

At 6 weeks after your fibula fracture, the bone is joined, but not ready for loading. At week 8-12 your fibula is fused. The treatment program is customized to your unique fracture.

Your fibula fracture can take longer than expected to heal, you must be on the lookout and be safe.

A follow up x-ray is taken at week 8 to ensure adequate bone healing did take place. Even if your bone is fused, there’s a lot of hurdles to overcome like, muscle strength, endurance, loading, stability before you can run.

Other forms of treatment

Your physio or GP confirms your fibula fracture via X-rays. GPs recommend pain meds or injections to control you pain and inflammation.

Casualties, X-rays, and send you home with moon boot. Remember the is a lot more to do to get you running, than just wait and see.

Orthotist fits the crutch, moonboot, or brace.

Orthopedic surgeon attends to more complex, compound, open fibula fractures.

Neurologist expertise is a necessity when a nerve is involved .

A biokineticist helps in the final stages of your rehabilitation and get you back to training for your specific sport.

Ozone therapy and calcium supplements only assist your healing process, but there are better things to speed up your recovery.

When will your broken fibula require surgery?

Surgery for a fractured fibula is rare as a fibula bone carries only 7% of your weight and is safer to treat with non-surgical treatment.

Surgery for your fractured fibula is necessary when…

You sustained a complex ankle fracture, which includes the lower part of your fibula bone. If your fibula bones fragments shifts and are compromises your surrounding nerves, vessels or muscles, then it needs to be surgically repaired. If you severely fractured your leg, which resulted in broken pieces of bone piercing through your skin (open fracture), then surgery is the obvious choice.

Surgery is only halfway mark for a successful recovery, the rest is the reintegration, strengthening and adapting your body to the new change.

What else could it be?

  • Peroneal nerve injury

A drop foot, with nerve type symptoms.

  • Peroneal tendinitis

Tendinitis pain gets better with movement, a fracture gets worse.

Severe instability in your ankle, while the X-rays show no fracture.

Also known as…

  • Lateral ankle fracture
  • Avulsion fracture of the lateral malleolus of the ankle
  • Tibia and fibula (Tib-Fib) fracture of the lower limb