Fibula injury?

[Dantheman]

For a couple weeks now I have been noticing some pain high on the outside of my ankle. I first suspected tendonitis of the peroneal tendons, but after really feeling around today the tendons seem fine and the source of the pain actually seems to be my fibula. If I feel up my fibula from the point of my ankle, about 2.5 inches up I hit a very tender spot. It is very localized, as wide as my finger at most, but quite sensitive and pain sometimes radiates further down my ankle.

Any thoughts? Possible stress fracture? Should I get an x-ray?

I ran a couple of ultras this summer, never had any ankle sprains or other acute injuries.

[jerlane]

Certainly could be a stress fracture. An xray might not be a bad idea, but may not show anything even if it is a stress fracture. If it is a stress fracture, treatment is symptomatic and primarily activity modification.

[Vinman]

DTM, A stress fx. in the fibula is possible if your milage was high as with running ultras. Does a bending force on the lower leg cause pain such as hanging your lower leg over a fulcrum of some sort and putting force on the ankle? Try squeezing the tib and fib, does this cause pain?

If these either of these are painful I would suggest a stress fx. and if your exam did not show signs of the peroneal tendons being the source (excellent strength without pain during resisted testing).

As jerlane mentioned generally the treatment is rest/ relative rest for ~6weeks to allow for the bone to heal. In your case relative rest would be non-weight bearing exercise, bike/swim/rower/upper body bike/ upper body lifting in seated position etc.

[Dantheman]

Does a bending force on the lower leg cause pain such as hanging your lower leg over a fulcrum of some sort and putting force on the ankle?

A little tricky trying this by myself, but no pain.

Try squeezing the tib and fib, does this cause pain?

Only when squeezing the sensitive spot in the fib, no pain squeezing above or below.

if your exam did not show signs of the peroneal tendons being the source (excellent strength without pain during resisted testing).

Resisted testing is a bit tough, under a load it is hard to tell whether the source of pain is the bone or the tendons. But if I very carefully massage the tendons and the bone separately, the tendons don't seem to be sensitive at all and it really feels like the sensitive spot is on the bone. From what I have read about tendonitis it sounds like the tendons are typically sensitive to touch/pressure. Also, tendonitis sounds like it is typically worse in the mornings, but I feel better in the morning and it gets worse throughout the day as I move around more.

Walking downhill seems to hurt the most, much more than running. I took Sam for a hike in the backpack last night and coming down with that extra 25lbs was the worst it has felt yet. The two ultras I ran were relatively short as far as ultras go (30ish miles), and I primarily trained using crossfit endurance so my overall mileage was relatively low.

[splat]

Go to the top of the fib and check for discomfort there. Could be like a minor movement out of place. Mine got all out of whack after my surgeries and I could feel it on both ends of my fib.

[Vinman]

DTM, you could go two routes with this. relative rest as I outlined above and Dr. consult/x-ray. But as Jerlane said the x-ray may not show anything. Stress fx. does not show up on x-ray until about 6 weeks after you begin rest. only then will a cloudy area indication bone healing show up. At this point the stress fx. diagnosis can be made. The only other tests that can show a stress fx. are a bone scan and MRI. Bone scan uses a short half-life radioactive marker that is absorbed by areas on injury in bones.

If it was my leg, I'd go with the rest and see what happens. But you have to stick to the plan for at least 4-6 weeks to allow the bone adequate time to heal or it will be useless.

[Jethro]

I had a tib/fib fracture back in '89. The doc put a rod through the tibula, and did nothing for the fibula. If the bone is not displaced, deal with the pain for a few to six weeks. Xrays will likely be a waste time and money as your doc will likely do nothing.

[jerlane]

I agree with Vinman. You really need to listen to your leg at this point. If something hurts, that's a sign that you're stressing the area. This is not a no-pain no-gain situation. If it hurts, don't do it and that includes walking. If it hurts to walk on, then you need to protect it further by taking some weight off of it, ie. walking stick/cane, or even a fracture boot. I doubt you would have to go that far, but be smart and treat this right the first time around and you should be in good shape for ski season.

[Dantheman]

If it hurts, don't do it and that includes walking.

Fuck me. That was exactly a question I was thinking of to ask while at work today. So basically everything is out except biking. I'm gonna go out of my mind without running, jumping and heavy lifting.

So you guys still think stress fx is the likely diagnosis even though I had negative results on the two tests Vin suggested? Treatment is probably the same no matter what so it doesn't really matter, I'm just curious.

[volklpowdermaniac]

I had a spiral fracture straight through my entire fibula, was walking around on it for three weeks because I thought it was a bruise, actually only acute impact and certian positins aggrevated it. Took two runs at crested butte, it killed, went to a doctor, sure enough broken. People vary with how much weight they bear through there fibula, my doc thought I was only at about 10% of my weight so walking didn't really bother it.

[Vinman]

Fuck me. That was exactly a question I was thinking of to ask while at work today. So basically everything is out except biking. I'm gonna go out of my mind without running, jumping and heavy lifting.

So you guys still think stress fx is the likely diagnosis even though I had negative results on the two tests Vin suggested? Treatment is probably the same no matter what so it doesn't really matter, I'm just curious.

Wait, did you get and x-ray or bone scan etc?

If the bone scan was negative then there definitely would be no stress fx. But if the result said something like stress reaction then that would indicate that you are on the road to a stress fx. but it has not yet fully developed.

Either way treat it based on clinical symptoms. If it hurts don't do it.

Biking, spinning, swimming, seated upper body lifting, upper body bike, push ups, sit ups, core work etc whatever you can occupy yourself with for a few weeks.

[lookinback]

I had several stress fx in my tibia/fibula this past ski season, all of them did not show up in a normal x-ray, a bone scan was needed to confirm that there was even anything there. If you do have a stress fx in that area you will need to stop any weight bearing activities, this includes running, hiking, and even excessive walking. Thats right take the bus everywhere, i would even recommend crutches for the first week. Each time you repeatedly load that area you are hindering healing. Although this does sound like a stress fracture I would also get your Anterior tib/fib ligament looked at (connects them at the head of the talus above the calcaneous) as this could also create some movement in the bones if slack resulting in slippage of the upper ankle that would create pain above the malleolus.

Go see a doctor

[Dantheman]

Wait, did you get and x-ray or bone scan etc?

Sorry, meant the leg-on-a-fulcrum and squeezing the tib-fib stuff.

[jerlane]

Sorry, meant the leg-on-a-fulcrum and squeezing the tib-fib stuff.

Even with these tests being negative, your story above is pretty convincing. The point tenderness in a focal area over the bone has me sold.

[Dantheman]

Well, I'll report back in 4-6 weeks. Gonna MTB/spin bike to keep the heart and lungs in shape and try and use this as an opportunity to work on gymnastics strength skills. I can already hold a single-leg front lever for 2-3 seconds, having a full one would be a pretty sweet showoff move to have in the bag.

[Tye 1on]

Yep, the crossfit's gotta take a break...

might be a good time to get into some swimming, cuz you know you'll eventually want to do a tri, if you haven't already!

[Vinman]

yeah DTM, the only way to go with this is relative rest. The fulcrum and squeeze tests need to be done by someone that knows what they are doing to interpreted the right way. Not even sure you'll find a fulcrum test in any text books. This is something I use only rarely.

I sort of stumbled on it when I had a kid complaining of a quad strain but said it hurt when he would sit with his legs/thighs over the end of the exam table. So when I re-created this bending force on the bone by placing my arm under his thigh and pressing down on his knee it recreated his quad pain. He later went on to have a positive bone scan for a femoral stress fracture.

[Tye 1on]

Dang, how do you stress fx a femur?

[Vinman]

same way as any other bone. in this case it was poor pre-season conditioning and a rapid increase in activity that was just too much for the bone to handle and a weak spot develops.

A stress fx. is not like a true fx. Bones are constantly being broken down and built back up basically remodeling. When the breakdown process becomes faster than the build up process it can create a weak spot. This usually occurs on the tension side of where a bone bends. Like bending a green tree branch or a piece of soft metal the material is stressed on the side where it is placed under tension, on the opposite side it would be placed under compression. This weak spot that is constantly being cause to micro bend under tension as we weight bear causes pain.....stress fx.

[Spats]

A stress fx. is not like a true fx.

I heart Vinman's medical posts.

[Vinman]

Aww I feel all warm and fuzzy now.

a stress fx. can degenerate in to a full fracture if not treated with rest however. Also a stress fracture can develop in non-weight bearing bones that are also repeatedly stressed in some way. Weight lifters and throwers can get upper extremity stress fx. Lots of folks get stress fractures in their lower backs, swimmers, gymnasts, football players and other who do lost of hyper extension of the spine.

[doublediamond223]

I fractured my fibula in April as a result of landing a spinning martial arts kick in a BAD way. It first just felt like a bad bruise on the outside of my ankle, and I thought nothing of it, assuming that I had kicked something solid. However, I fought on it for an hour the next day and couldn't walk at the end of sparring class. X-ray revealed a hairline fracture. 6 weeks in a cast SUCKED, but I'm almost back to 100% now.

Get it x-rayed, if it's broken then you need to immobilize otherwise it won't heal properly.

Vinman, are you an MD?

[Vinman]

No, I practice as a Certified Athletic Trainer.