A broken leg can significantly impact your ability to perform daily tasks, such as walking and driving. Rehab is often performed through physical therapy for a broken tibia and fibula to restore range of motion, strength and functional mobility.
Lower Leg Anatomy
The lower leg houses two long bones that run parallel to each other. The tibia is your large shinbone and runs on the inside of your lower leg. The fibula is a smaller bone that runs along the outside of the lower leg. The ends of these two bones form the bony bumps on either side of your ankle.
The tibia is the only lower leg bone that supports your body weight. According to MedScape, tibia fractures are the most common long bone injuries in the body. However, because the tibia and fibula are connected by strong tissue, fibula fractures can occur with trauma to the tibia.
The lower leg also contains important nerves and blood vessels. The common peroneal nerve wraps around the top end of the fibula and can be damaged with fibula fractures. If your lower leg fracture breaks the skin, damage to large arteries in the area can also cause significant blood loss.
Lower Leg Fractures
Fractures of the tibia or fibula require a period of immobilization to allow the bone to heal. This can be accomplished with a cast or removable brace, depending on the severity of your injury.
In some cases, such as the bone breaking into multiple pieces or if the bones can't be manually re-aligned, surgery may be required. This procedure, known as open reduction internal fixation (ORIF), involves the placement of plates and screws to keep the bone in the correct position. Sometimes fractures are externally fixated with temporary pins or other fixation devices that are removed once the bone heals.
Walking After a Broken Tibia or Fibula
Rehab typically begins with gait training after a broken tibia and/or fibula. Most of the time, you won't be able to apply weight to the injured leg for at least four weeks.
After that, you'll likely progress to being allowed to touch your toe to the ground, then partial weight-bearing of a specific percentage of your body weight, then eventually full weight-bearing. According to NYU Langone Medical Center, resuming normal walking after a broken tibia or fibula can take two to four months, depending on your specific injury.
Broken Leg Exercises
Physical therapy for a broken tibia and/or fibula might begin as early as one week after your injury. If surgery is required, a physical therapist might even see you in the hospital to train you in use of crutches.
Broken leg exercises can begin while your lower leg is still in a cast. Exercises such as straight leg raises and knee bending and straightening keep your hip and knee joints loose and help maintain some leg strength as your bone heals.
Straight Leg Raises
Straight leg raises strengthen the muscles around your hip and knee.
HOW TO DO IT: Lying on your back, bend your uninjured knee and place your foot on the ground. Straighten your knee on the injured side and lift the leg toward the ceiling — to the height of the bent knee. Slowly lower the leg. Repeat 10 times, working up to three sets in a row.
Ankle Range of Motion
Active range-of-motion exercises of the ankle to reduce stiffness begin after your cast is removed. Active movement also helps to decrease swelling. Perform exercises two to three times per day.
HOW TO DO IT: Sit in a chair or on the edge of a table with your leg off the ground. Perform ankle circles both clockwise and counterclockwise, 10 times each direction.
Point your toes down to the ground; then stretch them toward the ceiling, 10 times. Draw the alphabet in the air with your big toe, moving your ankle as far as possible in each direction, without pain.
Passive Stretching Exercises
Passive range-of-motion exercises are often first performed by your therapist, then can be taught to you as part of your home exercise program.
HOW TO DO IT: Sit with your leg straight out in front of you. Loop a towel or belt around the ball of your foot and hold one end in each hand. Gently pull the towel to stretch your toes toward your head. Stop when you feel a pulling sensation in the back of your calf. Hold for 20 to 30 seconds; then relax.
Repeat three times. Do not stretch to the point of pain — this can cause further damage to your healing bone.
Strengthen Your Ankle
Strengthening exercises for your ankle begin in a seated, or non-weight-bearing, position. A resistance band can be added to range-of-motion activities to strengthen your muscles, as part of your tibia fracture physiotherapy exercises.
HOW TO DO IT: Sit with your leg out straight. Loop the resistance band around the ball of your foot. Hold the ends of the band in one hand, or tie it to a secure object, such as a table leg.
Adjust the band as needed to perform resistance exercises in four directions — pointing your toes down, pulling your foot up toward your head, turning your foot inward and rotating your foot outward. Repeat 10 times in each direction, working up to three sets in a row. As the exercise becomes easier, use a band with increased resistance.
Train Your Toes
Toe-strengthening exercises help improve walking after a broken tibia or fibula by targeting the smaller muscles in your foot.
HOW TO DO IT: Sit in a chair with your feet on the ground. Place marbles on the ground next to your feet. Using your toes to grab a marble, lift them individually and place them in a cup. Repeat this activity for several minutes.
Alternatively, lay a towel flat on the ground and scrunch it up with your toes. Next, with your foot flat on the ground, lift your toes and hold for two to three seconds. Relax and repeat 10 times.
Common Peroneal Nerve Injury
The common peroneal nerve is a branch of the large sciatic nerve that runs along the back of your leg. Fibula fractures that occur close to the knee joint can also damage this nerve. Nerve injuries are diagnosed with electromyography, or measuring electrical signals in a muscle, and with nerve conduction tests, which assess how long it takes for electrical messages to travel along a nerve.
The common peroneal nerve powers muscles that lift your foot and toes up toward the ceiling and provides sensation to the outside of the lower leg and top of the foot. Damage to this nerve can make it difficult or even impossible to lift your foot as you walk, and you might catch your toe and lose your balance. This condition is called "foot drop."
You might also notice a slapping sound when your foot hits the ground. This can improve with strengthening exercises, but an ankle brace called an ankle-foot-orthosis (AFO) might be needed initially to assist with balance as your nerve heals. In rare cases, the common peroneal nerve can be torn with a fibula fracture, requiring surgical repair.
Get Your Balance
Balance activities begin once you're able to put full weight on your leg and are safely walking after a broken tibia and fibula. These exercises, sometimes called proprioception activities, re-teach your leg how to help you maintain your balance. Receptors in your muscles, tendons and ligaments provide feedback to your brain when you're standing to help maintain your balance. These receptors are off-duty when your broken leg is immobilized and need to be reawakened.
Weight-shifting exercises allow you to regain balance with the assistance of your uninjured leg.
HOW TO DO IT: Stand with your feet hip-width apart. Shift your weight over to the injured leg and hold for 10 to 20 seconds. Repeat three times. As your balance improves, lift up on the toes of your uninjured leg. Work up to standing on only the injured leg, with the opposite knee bent. At first, you'll likely need to put your arms out to your sides or hold onto a stable surface such as a wall.
Once you're able to balance on one leg, practice this activity with your eyes closed or while standing on an uneven surface such as a pillow.
Cardio Conditioning Activities
During recovery from a broken leg, your activity level — and endurance — drops significantly. Once your balance is adequate, conditioning exercises are added to your rehab routine to improve your tolerance to activity. These activities might include use of an elliptical, stair-climber or treadmill.
Running in a straight direction may begin 12 weeks after surgical repair of the tibia. Your specific timeline for resuming activities in physical therapy for a broken tibia and fibula will depend on several factors, including the extent of your injury, prior level of fitness and physical requirements of your job or sport.
Plyometric Training Exercises
Plyometric training, or jumping activities, are performed to increase speed and power. These activities place a high amount of stress on your legs and are often last to be added to your rehab exercises.
Plyometrics can include box jumps, broad jumps, squat jumps, clapping pushups and jumping rope. Progress with these exercises slowly under the supervision of your physical therapist to help prevent excess soreness and risk of re-injury.
Precautions and Considerations
Physical therapy for a broken tibia or fibula often includes modalities such as heat, ice, electrical stimulation and pneumatic compression to aid with pain and swelling during the rehab process.
Although some discomfort is expected during rehab exercises, notify your therapist right away if you experience sharp pain or increased pain and swelling following your exercise session.
In rare cases, a condition called complex regional pain syndrome can occur after a fracture in the leg. Other symptoms include sensitivity to light touch, cold insensitivity, color changes in the skin and decreased range of motion.
- Loughborough Hospital: Physiotherapy Following an Ankle Fracture
- MedScape: Tibia and Fibula Fracture in the ED
- Landmark Healthcare: Physical and Occupational Therapy Clinical Practice Guidelines: Tibia Fracture, Post-ORIF
- Current Trauma Reports: Rehabilitation of Lower Extremity Trauma: A Review of Principles and Military Perspective on Future Directions
- NYU Langone Medical Center: Rehabilitation Protocol: Tibial Spine Open Reduction Internal Fixation
- SportsInjuryClinic.net: Ankle Exercises
- MedlinePlus: Common Peroneal Nerve Dysfunction
- Mayo Clinic: Complex Regional Pain Syndrome