Have you had a fibula fracture and on telling your friends. They tell you It’s not a problem because It’s not a weight-bearing bone.
The truth is however much it is a non-weight-bearing bone, trying to heal from it can be very painful, long and difficult.
As usual, I address the most common questions from patients. I do so based on my experience as a diagnostic radiographer. Along with regular updates of my knowledge by consulting medical scientific publications related to the subject.
Happy reading!😀
Any questions? remarks? Let’s meet in the comments section at the end of this article.🙏
Last updated: July 2024. Written by Juliet Semakula, a diagnostic radiographer.
Disclaimer: no affiliate links.
▶️What does a fibula fracture look like?
The fibula bone is the outside bone of your lower leg (tibia). Whilst the fibula does not carry much of your body weight, it is an essential site of attachment for ligaments in both your knee and ankle joint.
The tibia bears approximately 80% of the body’s weight while the fibula bone bears only 15 to 20% of the body’s weight.
Fibula fractures commonly occur as part of an ankle injury. These injuries occur in a similar manner to a badly sprained ankle.
▶️What symptoms will you experience if you have a fibula fracture
🟣Pain or aches at the site of the fracture on the body.
🟣Tenderness to touch, swelling, or bruising.
🟣Visible signs of deformity: The bone might shift from its normal position.
🟣Inability to bear weight or take any form of pressure on the injured leg, walking or moving the leg can be very painful.
🟣Sensations of coldness or numbness in the foot.
▶️What are different types of fibula fracture?
There are different locations where the fibula bone can fracture. It can occur at the knee joint, above the ankle, in the shaft of the fibula bone, and at the ankle joint.
Here are the most common types of fibula fractures you could find written on your x-ray report.
🟣Avulsion fractures is a fracture in which a small part of the bone gets pulled off on the head of the fibula.
🟣Mid-Shaft fibula fracture is a break that often affects the middle of the leg due to direct impact
🟣Fracture of the external ankle malleolus (A fracture at the distal fibula.
🟣Fracture of the head of the fibula: this affects the upper part of the fibula near the knee, this type of fracture is associated with complications due to the muscles, ligaments, and interosseous membrane attachments in that location.
🟣Stress fracture is a hairline fracture due to repetitive injury
🟣Displaced fibula fracture
X-ray images showing various fractures of the fibula bone
▶️What is the treatment for a fibular fracture?
Management of fibula fractures depends on fracture type, displacement and associated ankle instability. There are two types of treatment.
1️⃣Conservative or orthopaedic treatment: No surgery involved.
2️⃣Surgical treatment to stabilise, realign and promote healing of the fracture
Most Fibula fractures are treated by immobilisation, this is done either with a controlled Ankle Movement walking boot, cast, splint or surgically installed screws and plates depending on the distance between the fractured fragments or simple precautionary instructions.
▶️Conservative management
For simple, minimally displaced fractures without ankle instability, conservative treatment is used because it has been proven to provide excellent results.
Non-casted fibula fracture and a walking boot
You may wonder how only immobilisation with a walking boot, splint and crutches can initiate healing.
The trick is immobilisation with a boot brings the fractured segment closer to the blood clot. The hematoma initiates the healing process, growing from a soft callus to a hard, rigid callus to remodelling which fits the space to initiate healing.
Caution! Excessive or early weight bearing can displace the blood clot and interrupt healing.
Some people wonder if a broken fibula can heal without a cast the answer is ‘YES’
🟢If your fracture is stable and non-displaced
🟢And you have not injured your tibia or ankle bone.
However, (and very importantly) it doesn’t work in all cases. Likewise, a broken bone left to heal without a cast may heal improperly.
▶️Walking boot for fibula fracture
When you have had the initial phase of treatment, sitting on the couch and letting it heal on its own is probably not the best approach.
While your fibula is healing, you should stay mobile using a walking boot with the help of crutches if you need to speed up the recovery process.
The controlled ankle movement (CAM) walking boot used to immobilise the fibula fracture comes in three:
1️⃣The controlled ankle movement walking boot wraps the foot, ankle and lower leg below the knee.
2️⃣The non-inflated controlled ankle movement walker which provides basic support to the fractured fragments.
3️⃣The inflamed controlled ankle movement walking boot is where the bladder is inflated with air to increase stability and accommodate swelling in the leg.
This kind of boot allows nature rocking motion on the foot during walking and it is possible to adjust the boot to allow a restricted range of motion.
As the fibula heals, the Controlled Ankle Movement walking boot is replaced by a plastic air stirrup -type brace or an ankle lace up brace.
Example of a Controlled ankle movement boot
▶️Why a boot and not a cast?
Casts are used on more displaced fractures because they provide almost total immobilisation.
Surgical boots and splints are often used to limit but provide some controlled movement to help the tissues to heal.
Also to prevent further injury from the impacts of leaving the leg unprotected and to help your walk.
▶️Surgery for a fibula fracture?
Surgery intervention using Open reduction and internal fixation are the most common treatments for unstable displaced fibula fractures.
A dynamic compression plate and locking plate with or without an independent lag screw is used to stabilise the fracture.
Distal fibula fractures in elderly patients are often comminated and present with impaired soft tissues coverage.
Consequently, the correct management of fibula fractures in these patients must account for bone quality and the risk of soft tissue complications (Minihane 2006).
The goal is to realign the bone fragments and secure them in place to help with the healing process.
▶️Can you walk with a broken fibula?
Your fibula isn’t weight bearing (it doesn’t support your body when you stand or move).
On the same day as the fracture occurs, you can resume walking with the help of crutches or a walker.
Until you see an orthopaedic doctor to either be allowed to weight-bear or not.
You may be advised not to put weight on your fractured fibula for at least 4 to 6 weeks until the hard rigid callus has formed and remodelled to avoid healing interruptions.
I have seen patients walk with a fibula fracture on the same day, but it is always advisable to follow gradual weight bearing steps before you fully start walking.
Step 1: Weight-bearing on the healing leg progresses from non-weight bearing. This means you should not put weight on the healing leg.
You can use a wheel walker, crutches or a knee scooter to help you move around.
Step 2: Touch weight bearing is when the foot and toes are touching the floor. It gives the muscles of the leg a break from holding the leg up. It also helps the leg to become accustomed to minimal weight bearing.
Step 3: Partial weight bearing to weight bearing as tolerated. Partial weight-bearing gradually allows the leg to hold more weight – up to 50% of your body’s weight.
Step 4: Full weight bearing. Finally, full weight bearing is 100% of the body weight on the healing leg with no assistive device.
However, you shouldn’t ignore pain or other symptoms in your leg. Even if you can move or walk, you should get your injury examined by your doctor.
▶️Can you walk on a broken fibula after 4 weeks?
At around four weeks, patients come back for a check x-ray to assess the healing progress.
There you will be advised by your doctor whether to walk without crutches and how much weight you can put on your affected leg.
▶️What is the total recovery time when you have broken your fibula bone?
Healing of a tibial fracture will depend on other factors such as:
⚫Your age.
⚫Level of vitamin D.
⚫The type of fracture you have got.
You can help by speeding the healing process by getting adequate rest, not putting too much weight on the leg, minimising smoking and following your doctors’ instructions.
If you choose to be active, you can cause a lot of problems:
⚫Interference with the natural healing time, such as not following the weight-bearing status from the physician, can displace the hematoma, and the bone cannot heal.
⚫ Too much motion early at the fractured site prevents the hard, rigid callus from forming, resulting in non-union of the fracture fragments. The fractured site can then become unstable.
⚫Poor blood supply to the fractured site also prevents the formation of the hard, rigid callus. That is why smokers have a hard time healing. Smoking decreases blood supply to the fracture site.
As the bone heals completely, I have seen patients resume walking normally between 1 to 6 months after.
Here are some indicative recovery timelines I see with patients who come to the orthopaedic clinic at my workplace.
| Stages | Usual Timeline from the day if fibula fracture |
| Significantly reduced pain | 2-3 weeks |
| Swelling in your leg/foot subsides | 6-8 weeks |
| Resume walking with crutches Non-weight bearing badly displaced fractures | Immediate Recommend 4 to 6 weeks, no putting weight on your fractured leg |
| Stop using a walking boot and crutches | Try to stop using the boot and crutches after 6 weeks to 3 months. Practice walking without your boot and crutches around your home first. Build up to longer walks outside. |
| Ability to drive | 6 weeks -12 weeks |
| Bone remodelling | 6 to 8 weeks for the hard, rigid callus to form & remodelling to begin |
| Average time for bone healing Complete healing with surgery | Can take 8 to 10 weeks Can take 3 to 6 months or 1 year |
These are the average recovery timelines.
▶️Fibula fracture and swollen foot is it normal
It is normal to have mild pain and swelling for 3 to 6 months after the fibula fracture. This swelling is called Edema, and it gradually decreases over the weeks regardless of your actions.
Why does this swelling occur?
1️⃣Due to reduced movement.
2️⃣Inflammation
Recommendations to help reduce swelling in your foot.
⚫Walking with your boot on will not only help protect your ankle it will make you more comfortable. Wearing the boot when you are standing and walking for the first two weeks will help reduce swelling on your foot.
⚫Consider wearing compression socks or stockings.
⚫Limit long hours of standing and sitting down.
⚫Elevate your foot several times a day.
We have come to the end of this article, I hope I have answered some of your common questions. Wishing you a quick recovery!🙋
📚Source:
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Jehlicka D, Bartonícek J, Svatos F, Dobiás J. [Fracture-dislocations of the ankle joint in adults. Part I: epidemiologic evaluation of patients during a 1-year period] Acta Chir Orthop Traumatol Cech. 2002;69:243–247. [PubMed] [Google Scholar] [Ref list]
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