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.

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.

(Image: kokouu/iStock/GettyImages)

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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.

Read more: Exercising with a Tibia Fracture

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.

Read more: Exercises That Reduce Ankle Swelling

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.

Read more: Ankle Inversion & Eversion Exercises

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.
 (Image: kokouu/iStock/GettyImages)

VIDEO OF THE DAY

Volume 0%
00:10

00:48

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.

Read more: Exercising with a Tibia Fracture

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.

Read more: Exercises That Reduce Ankle Swelling

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.

Read more: Ankle Inversion & Eversion Exercises

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.