Ankle Fractures (Fibula) Causes, Symptoms & Treatment

Overview

The fibula is a long, thin bone on the outside of the leg that extends from the knee to the ankle. Most of your weight is carried by the larger bone in your leg called the tibia (shin bone).

At the ankle joint, the fibula is often called the lateral malleolus, and when the fibula is broken at the ankle, it may be referred to as a lateral malleolus fracture. The fibula can be broken or fractured anywhere along its course, from the outside of the knee to the ankle.

Pain below the fibula is often associated with an ankle sprain, while pain on the bone itself can be associated with a fracture. When you have a lateral malleolus fracture, it is likely very painful to bear weight, and there is pain if you touch the bone itself on the outside of your ankle. Both ankle sprains and fibula fractures occur from a similar mechanism, frequently by your ankle rolling under you. You may hear a pop or crack. This is frequently associated with bruising and swelling of your ankle.

What causes Ankle Fractures (Fibula)?

Ankle fractures involving the fibula usually occur when the ankle twists or rolls inward or outward. These injuries are common in both sports and daily activities. They can also result from a direct blow, fall, or other traumatic impact. Over time, repetitive stress without enough rest can lead to a stress fracture in the fibula.

• How the Injury Occurs: Sudden twisting, rolling, or direct impact to the ankle can cause a break in the fibula. Repetitive strain without sufficient rest may also lead to stress fractures over time.
• Common Everyday Causes: Can occur from everyday incidents such as slipping on uneven surfaces, missing a step, or landing awkwardly during routine movements.

Ankle Fractures (Fibula) are most common in the following sports:

• Running: Repetitive impact can overload the distal fibula.
• Basketball: Sudden pivots and jumps increase fracture risk.
• Soccer: Rapid directional changes and tackles can cause fibular ankle fracture injury.
• Football: High-impact collisions and twisting motions predispose the ankle to fracture.
• Tennis: Quick lateral movements place stress on the lateral malleolus.
• Skiing: Falls or awkward landings may result in acute fibular fractures.

Symptoms

Pain is the primary symptom of an ankle fracture, appearing immediately after injury and ranging in severity from mild to intense. Other features may include:

• Activity-dependent pain: Discomfort that worsens with walking or movement and improves with rest.
• Swelling and ecchymosis: Swelling and bruising frequently develop around the ankle joint shortly after injury.
• Localized tenderness: Pressing over the fibula, especially near the lateral malleolus, causes marked pain.
• Impaired weight-bearing: Patients often experience difficulty or an inability to stand or walk on the injured ankle.
• Ankle deformity: In more severe cases, the ankle may appear misaligned or abnormally shaped.

Non-operative treatment

Management of ankle fractures is primarily determined by the location, type, and severity of the fracture. Stable, non-displaced fractures are often treated conservatively without surgical intervention. Initial treatment focuses on limiting movement and protecting the ankle to ensure proper bone healing. Standard conservative measures include:

• Ice therapy: Application of cold compresses to reduce pain and limit swelling.
• Elevation: Keeping the injured leg elevated above heart level to decrease edema.
• Pharmacologic pain relief: Administration of nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, to manage pain and inflammation.
• Immobilization devices: Use a splint, cast, walking boot, or supportive brace to maintain ankle stability and alignment during healing.
• Rehabilitation exercises: Gradual physical therapy to restore range of motion, strength, and functional mobility once the fracture has sufficiently healed.

Once your recovery is complete and your doctor has approved it, begin the following exercises to support your rehabilitation:

Click the link below to view the Ankle Fracture Exercise Program PDF.

Ankle Fracture

Surgical Treatment

If the ankle fracture is unstable or out of place, surgery may be the appropriate treatment option. In such cases, surgery can help restore proper ankle function and reduce the risk of developing arthritis. During the procedure, the orthopedic surgeon realigns the broken bones and secures them with pins, screws, or plates. The surgeon may also use arthroscopic surgery, a minimally invasive technique, to operate on the ankle.