You will be followed up by the consultant.
This is a follow-up letter to your recent telephone consultation with the fracture care team explaining the
ongoing management of your injury. Your case has been reviewed by an Orthopaedic Consultant (Bone
Specialist) and Fracture Care Extended Scope Physiotherapist.
You have sustained a stress fracture to your distal bula near your ankle joint.
A stress fracture is typically an overuse injury. It occurs when muscles become fatigued and are unable to
absorb added shock. Eventually, the fatigued muscle transfers the overload of stress to the bone causing a
tiny crack called a stress fracture. Stress fractures often are the result of increasing the amount or intensity of
an activity too rapidly.
They normally takes approximately 6 weeks to unite (heal) although pain and swelling can be ongoing for
3-6 months.
You may walk on the foot as comfort allows although you will nd it easier to walk with crutches in the early
stages.
The swelling is often worse at the end of the day and elevating it will help. The boot you have been given
is for your comfort only and is not needed to aid fracture healing, but should be worn at all times when
walking. Take pain killers as prescribed.
If you are worried that you are unable to follow this rehabilitation plan, or have any questions, then please
phone the Fracture Care Team for advice.
Picture of injury
If you are experiencing pain or symptoms, other than at the site of
the original injury or surrounding area, please get in touch using the
telephone details at the top of this letter.
You have also been referred to fracture clinic to check on
your progress. They will oer on-going advice with regards to
rehabilitation. They may require further x-rays and this will be
decided by the consultant on the day.
If you have not received a letter for this appointment or need to
change this appointment, please contact the booking team on Tel:
01302 642500.
WPR45020 Oct 2017 Review date: Oct 2019
Doncaster and Bassetlaw
Teaching Hospitals
NHS Foundation Trust
We
Care
Out Patient Fracture Care Team:
Shared care plan
Doncaster Royal Inrmary
Armthorpe Road
Doncaster
DN2 5LT
Tel: 01302 644665
Stress Fracture Distal Fibula
Please follow the Management/rehabilitation plan shown below:
Weeks since injury Rehabilitation plan
0-6 Wear the boot all of the time when walking. Use the crutches to take some of the
weight o of your foot. It is ok to take the boot o at night and when resting at home.
It is also important to perform the exercises below regularly to get the movement
back.
6-8 Try and wean yourself out of the boot and walk without the crutches. Try walking
around the house at rst. You will want to wear it if you go on a long walk. Start the
exercises below labelled ‘Exercises from 6 weeks onwards’.
8-12 The fracture is united (healed) and you can begin to resume normal activity but be
guided by any pain you are experiencing. You should be able to carry out day to
day activities. Arduous tasks, long walks etc., may still cause some discomfort and
swelling.
12 If you are still experiencing signicant pain and swelling then please contact the
Fracture Care Team for advice.
Initial advice
Cold packs:
A cold pack (ice pack or frozen peas wrapped in a damp towel) can provide short term pain relief. Apply this
to the sore area for up to 15 minutes, every few hours ensuring the ice is never in direct contact with the
skin.
Rest and Elevation:
Try to rest the foot for the rst 24-72 hours to allow the early stage of healing to begin. Raise your ankle
above the level of your hips to reduce swelling. You can use pillows or a stool to keep your foot up.
Early movement and exercise:
Early movement of the ankle and foot is important to promote circulation and reduce the risk of developing
a DVT (blood clot). Follow the exercises below without causing too much pain. This will ensure your ankle
and foot do not become too sti. These exercises will help the healing process.
Early weight bearing (putting weight through your injured foot) helps increase the speed of healing. Try to
walk as normally as possible as this will help with your recovery.
Smoking cessation
Medical evidence suggests that smoking prolongs fracture healing time. In extreme cases it can stop
healing altogether. It is important that you consider this information with relation to your recent injury.
Stopping smoking during the healing phase of your fracture will help ensure optimal recovery from this
injury.
For advice on smoking cessation and local support available, please refer to the following website:
http://smokefree.nhs.uk or discuss this with your GP.
Physiotherapy
Physiotherapy
Initial exercises to start straight away (3-4 times a day)
Ankle and foot range of movement exercises. Repeat these 10 times each.
1. Point your foot up and down within a comfortable range of movement.
2. With your heels together, move your toes apart, as shown in the picture.
3. Make circles with your foot in one direction and then change direction.
Exercises from week 4 onwards
Ankle stretches
1. Sit with your leg straight out in front of you. Put a towel/bandage around your foot and pull it
towards you. Feel a stretch in the back of your calf.
2. Point your toes down as far as they go, then use the other foot on top to apply some pressure to
create a stretch on the top of your foot.
Hold both stretches for up to 30 seconds and repeat 3 times.
Exercises from week 6 onwards
Balance strategy exercises
Level 1: For patients who could not stand on one leg before their injury.
a) Stand with your feet as close together as
possible, using something rm to hold onto.
Hold this for 30 seconds. If you can do this
move onto Level 1b.
b) As above, but removing your hand so that
you are balancing. Hold this for 30 seconds. If
you can do this move onto Level 1c.
c) Holding onto something rm, put one foot
in front of each other as close together as you
feel comfortable with.
Hold this for 30 seconds. If you can do this easily you may like to try without holding on, but only if you feel
condent to do so.
Physiotherapy
Level 2: For patients who could stand on one leg before their injury.
a) Holding onto a rm surface, attempt to stand on
one leg. Hold this for 30 seconds, making sure it does
not induce any pain. Once you can achieve this pain
free, move to Level 2b.
b) As above, but removing your hand so that you are
balancing. Hold this for 30 seconds. If you can do this
move onto Level 2c.
c) Once condent with your eyes open, progress to
attempting this with your eyes closed. Always stand in
a safe environment with a rm surface close by should
you need it. Hold this for 30 seconds.
Advanced exercises for sports rehabilitation
Stage 1: For patients who would like to develop dynamic ankle control for sports.
a) Standing on an uneven surface such as a doubled-over pillow or wobble
cushion, attempt to balance for 30 seconds. Once you can achieve this pain
free, move to Stage 1b.
b) Once condent with your eyes open, progress to attempting this with your
eyes closed. Always stand in a safe environment with a rm surface close by
should you need it. Hold this for 30 seconds.
Stage 2: For patients who would like to develop dynamic core control for sports
a) Stand with one foot in front of the other, with your hands together. Swing
your arms in a gure of eight in both directions for 1-2 minutes, or as able.
b) As above, but bring your feet so they are touching toe to heel.
c) As a) and b) above, but with your eyes closed.
