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Why do we have the tibia and fibula (a 2nd bone) in the lower leg?

Why do we have the tibia and fibula (a 2nd bone) in the lower leg?



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Does fibula participate in rotational movement of ankle or not (just like the radius in forearm)? If not, what is the purpose of that bone?


It does function in the rotation and stabilization of the foot, but that is not why we have it, even species in which it serves no function still have it. A bone does not necessarily have to have a purpose in an organism, instead it can have on in its ancestors.

We have this arrangement becasue we inherited the basic limb bone arrangement from our fishy ancestors. Basically all tetrapods share the same pattern of bones in their limbs, one bone, two bones, many small bones, followed by several groups of long thing bones. this goes for front and hind limbs.

tetrapod evolution


External Fixation

External fixationof the lower leg is a surgical procedure to externally immobilise and fix a bone following a fracture allowing the bone to heal effectively. Physiotherapy after external fixation surgery is essential to mobilise and return function in the lower leg.

  • Non-displaced (bones are still in position)
  • Displaced (out of position)
  • Closed fractures (where the skin is not broken by the fracture fragments)
  • Open fractures (where the fracture fragments have broken through the skin)
Above: Rolling soft tissue massage of the gastrocnemius muscle


The skin and tissues that cover the front of the tibia and fibula are very thin and as a result of this, a significant number of fractures to the lower leg are displaced, open fractures.

The main symptoms that follow a fracture to the lower leg include severe pain and reduced mobility as the leg will be extremely painful and difficult to move. With fractures of the lower leg there will be deformity at the site of the fracture, especially with open fractures. As a result of the large amount of tissue damage and loss of blood at the fracture site, there will also be a considerable amount of swelling and discolouration.

Treatment of lower leg fractures can vary depending on the severity of the fracture. If the bone is still in its correct alignment (non-displaced) then immobilisation with use of a splint or cast followed by physiotherapy is recommended. If the fracture is out of position (displaced) but the skin is still intact (closed fracture) then ORIF of the lower leg (open reduction internal fixation) is required.

In severe cases, external fixation surgery is necessary. External fixation surgery is a method of holding together the fragments of a fractured bone by using transfixing metal pins through the fragments and a compression device attached to the pins outside the skin surface. The main indications for the use of external fixation surgery are in cases where there has been a displaced, open fracture (the bone is out of position and has broken through the skin). Also external fixation is indicated when there is high risk of infection, considerable bone loss at the fracture site, and when other methods such as ORIF of the lower leg are inappropriate. Common types of external fixation used in the treatment of a lower leg fracture include X-Fix and Llizarov.

External fixation is a procedure that sets and immobilises the fractured bone in its correct alignment so as to enable and facilitate adequate healing of the lower leg. The method provides rigid fixation of the bones outside the body (external) in cases where other forms of immobilizationare inappropriate. External fixation is performed in an operating room, normally under general anaesthesia. During external fixation small holes are drilled into uninjured areas of bones around the fracture and special bolts or wires are screwed into the holes. Outside the body, a rod or a curved piece of metal with special ball-and-socket joints joins the bolts to make a rigid support. The fracture can be set in the proper anatomical configuration by adjusting the ball-and-socket joints. After the rods are fixed, regular cleaning where the pins have been insertedmust be performed to prevent infection at the site of surgery.In most cases it may be necessary for the external fixator to be in place for many weeks or even months. Most fractures of the lower leg heal from between 6 and 12 weeks. After this time the external fixators are removed using specialised wrenches and can be removed without any anaesthesia.

Once the external fixator has been removed, it is imperative to undergo a comprehensive and prolonged course of physiotherapy to maximise the success of the procedure and to help ensure the return of full or near to full function in the lower leg post fracture.

Above: Deep tissue massage of the gastrocnemius muscle

Symptoms

Symptoms of a tibial stress fracture are very similar to shin splints (medial tibial stress syndrome) and include:

  • Pain on the inside of the shin, usually on the lower third.
  • Symptoms often occur after running long distances.
  • When pressing in over the area your leg will feel tender and sore.
  • You may even have swelling over the site of the fracture.
  • If you have a stress fracture you may also feel a particularly tender spot at the exact point of the stress fracture.

Diagnosis

It can be difficult to distinguish a tibial stress fracture from a case of shin splints. This is because a stress fracture will not show up on an X-ray until it has begun to heal. It is the new cells along the line of the fracture which will become visible.

  • If you suspect a stress fracture of the tibia then a period of at least 4 weeks rest is required before a second X-ray is taken.
  • Often new bone growth can be seen where it has begun to heal.

Function

All long bones are limb bones that assist with weight-bearing and movement. The bone marrow found in the shaft of all long bones, including the tibia, is mostly red bone marrow, which assists in the production of red blood cells. As a person ages, red bone marrow is replaced with yellow bone marrow made up of mostly fat.

The tibia provides stability and bears weight for the lower leg. It provides leverage for the leg to propel a person through movement and facilitates walking, running, climbing, kicking, etc.


General Cancer Symptoms

Hip Bone Cancer Symptoms

As with any type of cancer, bone cancer of the tibia can cause generalized symptoms 2. Symptoms may include:

  • fevers
  • chills
  • night sweats
  • unexplained fatigue
  • changes in appetite
  • unintentional weight loss

These symptoms might indicate that the tibial tumor is metastatic and the primary tumor may be located elsewhere in the body 2.

Seek medical care as soon as possible if you experience any signs or symptoms that might indicate a tumor of the tibia. While the possibility of cancer is scary, keep in mind that most bone tumors are not cancerous. Even if cancer is diagnosed, early detection and treatment give you the best chance for a cure.


Delayed Union or Non-Union on Tibia fracture?

I am a 58 year old woman who suffered a compound fracture of the tibia in my right leg in 2008 as the result of a motor vehicle accident. I had the titanium rod and plate removed from my leg and ankle after several months and made a full recovery. My ankle was also freed up during the removal operation and my mobility increased as I had a pinched nerve in my leg from the rod so it was quite a relief. I then responded much more positively to physio and exercise. I still have some nerve sensitivity in my ankle and down my leg but it is not intolerable.

Unfortunately in May 2010 I slipped and fell near my swimming pool and sustained tibial plateau fracture of my left leg. 7 months on after having 7 weeks in a wheel chair with non-weight bearing, several months on crutches, I am now dependent on a walking stick but moving much better. I am having weekly physio sessions and have returned to my personal trainer for strength training. However, to this day I am still suffering from severe pain in my knee and down my leg where the rod is and wonder if I should have it removed earlier than the 2 years predicted by my surgeon. I also suffer from low back pain, hamstring and and tightness in the gluteus maximus. I have adhered to all the stretching exercises prescribed and try to walk as much as possible as sitting is not good for tight glutes/ham strings. I also work out in my heated pool and go to the beach so I can relax in the salt water. I regularly take glucosamine tabs, magnesium for cramps and have regular epsom salts baths. At the moment I am very disillusioned about my recovery but am not one to give up.

I am considering approaching my surgeon to remove the rod and plate, however, prior to my car accident and fall, I underwent chemo and radiotherapy for breast cancer so have low bone density and am concerned that removal of the rod will put me at risk for further fractures!

Any comments or advice from your personal experiences would be gratefully appreciate.


Muscles of the Lower Leg

For most of us, we get up every morning, get out of bed, and take on the direction that our day takes us. We do this by moving from one place to the next through walking. We take walking for granted because it is so automatic, but our legs have muscles that we are not even aware of, until we have a problem and have to seek medical attention. Here are the muscles in our lower leg that help to propel you each day.

Anterior Muscles of the Lower Leg and Their Functions

The anterior is located in the front portion of the leg. These are the muscles that are located there:

1. Tibialis Anterior

This is the biggest muscle that is in the tibialis anterior. It gets its blood flow from the arteries in the tiberial artery. This muscle is one of the ones that help the foot flex forward at the ankle and allow the toes to extend. The tibialis anterior muscle comes from the shinbone. It joins the bone in the foot that is known as the first metatarsal which is right behind the big toe.

2. Extensor Hallucis Longus

The job of the halluces longus is to stretch out the foot's big toe. It also helps to direct the toes so that they can be closer to the shins. This muscle assists the inversion of the foot which is what happens when the foot shifts to its outer edge. Since this muscle has so much to do with the foot's big toe, if it becomes injured in any way it could affect the way the person walks.

3. Extensor Digitorum Longus

This muscle can be found in the front of the leg and its job is to extend the foot from the position of the ankle. It is also responsible for moving the other four toes. If you strain this muscle you will feel it when you try to climb the stairs. You may want to stretch your shin regularly to prevent any inflammation. Toe raises can also help keep it in shape.

4. Peroneus Tertius

This muscle is also known as fibularis tertius and can be found on the lower portion at the front of the leg. It attaches to the fibula which is one of the two main bones in the lower part of the leg. This muscle has two functions: to assist the toes in the direction of the shin, which is called dorsiflexion, and eversion, which is directing the foot away from the middle of the body. If you have a problem with this muscle it will show up in the form of heel and ankle pain. Apply ice and take a NSAID (ibuprofen) for relief.

Posterior Muscles of the Lower Leg and Their Functions

This portion of the leg has seven muscles in it that are separated into two parts &ndash superficial and deep.

1. Superficial Muscles

The muscles in this category form what is called the calf at the back of the leg. All of these muscles stem from the heel of the foot through the calcaneal tendon. There are two tendons involved that help to cut down on the friction caused by the movements.

This muscle has two parts, the lateral and the medial and they both meet in the middle to form a single muscle. The gastrocnemius is the muscle that is in charge of forceful movements. Whenever you run or jump this muscle is doing its job.

Because this muscle is small, slender and runs down the leg, it can be viewed as a nerve by mistake. Around 10 percent of people do not even have it. It stems from the ankle and goes across the knee but is not responsible for any major movements.

This muscle can be found inside the gastrocnemius. Because it is flat and large, it looks like a flat fish. It is responsible for plantar flexing the foot from the point of the ankle joint.

2. Deep Muscles

This area consists of four muscles in the back of the leg. The popliteus works on the knee while the other three are associated with the foot and ankle.

This muscle is located on the side of the leg and is actually on the other side of the large toe which it is responsible for moving. It is attached to the plantar of the large toe and it helps to flex it.

This small muscle is found in the middle of the back of the leg. It comes from the tibia and joins the plantar surface that attaches the four toes. It works to flex those toes.

This one can be found between the flexor hallucis longus and the flexor digitorum longus. It is the deepest of all four muscles. It comes from the membrane that lies between the fibula and tibia and the back of the two bones. It is responsible for inverting the foot and keeping the medial arch of the foot intact.

This muscle can be found right behind the knee. Its main function is to rotate the femur laterally so that it unlocks the knee joint so that it can bend and move more easily.

Lateral Muscles of the Lower Leg and Their Functions

The lateral portion of the leg has two muscles in it and they used to be called peroneal brevis and longus. They are also known as fibularis brevis and longus. Both of these muscles work together to help the foot turn sideways with the sole facing out.

1. Fibularis Longus

The longer of the two fibularis longus has an unusual course through the leg. It starts at the lateral portion of the fibula and tibial condyle its fibers join into a tendon that gravitates towards the foot and then crosses under the foot attaching itself to the bottom of the metatarsal. It is responsible for arching the foot.

2. Fibularis Brevis

This muscle is shorter and even deeper than its counterpart. It starts at the surface of the fibular shaft then it evolves into a tendon traveling to the bottom of the foot. It ends up on metatarsal V. Its job is to help the foot turn on its side.


How we care for leg fractures

Every year the Orthopedic and Sports Medicine Center at Boston Children&rsquos Hospital treats thousands of children, adolescents, and young adults with fractures of all complexities. Our pediatric expertise allows for accurate diagnosis of conditions related to the growing musculoskeletal system and development of optimal care plans.

Our Orthopedic Urgent Care Clinic treats patients with orthopedic injuries that require prompt medical attention but are not serious enough to need emergency room care. We offer urgent care services in four locations &mdash Boston, Waltham, Peabody, and Weymouth.


Physical therapy for a tibia and fibula break

The tibia and fibula are the two bones of the lower leg. It’s unusual to break both bones, even in contact sports like football. It takes quite a bit of trauma to break both of them at the same time. The footage of the Washington Redskins quarterback, Alex Smith, breaking both of these bones is hard to watch.

Anyone sustaining a double break like this would go directly to surgery. The severity of the break can vary, but there are some standard things that anyone who breaks these bones will go through.

NON WEIGHT BEARING PERIOD OF PHYSICAL THERAPY

The biggest factor is that the tibia is a weight bearing bone. Just like a load-bearing wall in a house, the tibia is integral to our physical structure and without it we can’t stand up. Any time a bone is broken we have to remove pressure on that bone to allow it to heal. This contributes to the prolonged healing time and requires a period of about 6 weeks where no weight is put on that leg. Depending on the severity of the break and the complexity of the surgery that time could be even longer. This initial healing period is extremely difficult because not putting weight on the bone causes atrophy of the surrounding muscles.

During the period of non-weight bearing recovery, rehabilitative procedures can be done to encourage healing. This is where having a great physical therapist with an extensive skillset, like ours at Rose Physical Therapy Group, is essential. Management of swelling and circulation, gentle working out of the other leg and upper body, maintenance of range of motion of the toes, ankle, knee and hip, are all important to the recovery process. These procedures are performed with great skill, and applying these skills in the right way can significantly decrease the time it takes to return to normal activity once the bone is healed.

WEIGHT BEARING PERIOD OF PHYSICAL THEARPY BEGINS

Traditionally physical therapy is brought into the equation a little later in the healing process, after the bone has healed enough to begin putting weight on it. However, a skilled PT would recommend starting gentle therapies before that to maximize outcomes and improve tolerance to harder therapies later on.

The athlete will return to weight bearing activities after the bone has healed. Initially physical therapy will include gentle strengthening and stretching. Weight distribution onto the broken leg is performed in carefully selected stages, starting slowly and with light weight at first.

As the strength of the bone and muscle builds, more activity is allowed. This is a time when staying in touch with the surgeon is important. At this stage the surgeon ensures that everything done in therapy is within the bounds of what the surgeon recommends based on the structural integrity of the Tibia. It also means pushing into new boundaries as healing allows. It’s not good to fall behind in the rehab schedule.

BACK TO BASIC ACTIVITIES

Once there is enough healing to go back to basic activities such as walking without crutches then the real work begins. This is the time when the muscles are weakest from disuse and the freshly healed bone is fragile. Strengthening and mobility begin in earnest and can be quite a lot of work. Workouts that previously would have felt easy will be quite difficult. With hard work and guidance from a physical therapist strength grows and athletic ability can be regained.

Over time the workouts go from unloaded exercises like leg raises, to loaded exercises like squats to impact exercises like jumping. It’s a slow journey. The job of the physical therapist is to assess form and to progress things in a safe way to make sure no further injury or re-injury occurs.

QUALITY OVER QUANTITY: WHAT TO LOOK FOR IN GREAT PHYSICAL THERAPY

A really great physical therapist will also incorporate care for scar tissue and tissue mobility. Once an exercise is mastered that exercise becomes part of a home exercise program so that the time spent in therapy is used for the things that cannot be done at home. We spend a lot of time and effort perfecting our skills and abilities, we do not need to spend time watching exercises. Therapy time is for therapy.

A broken bone is never fun. Breaking both the tibia and fibula together is devastating. Part of what makes Alex Smith’s recovery favorable is access to top quality care. Fortunately there are lots of resources, even for normal folks, to make recovery possible. At Rose Physical Therapy Group we offer one-on-one care, one-hour appointments and we accept insurance. But these things are just the framework for good physical therapy care.

Rose Physical Therapy is setup to make the best physical therapy accessible to you by giving our therapists enough time to treat you in an environment that is centered around medical care, convenient to downtown Washington, DC and Capitol Hill / Capitol Riverfront / Navy Yard on the Southeast side of the District. All of this framework is important, but it shouldn’t just be about the convenience of a clinic to your geographic location in the city, or your commute. The key to all of this is the extra expertise that every Rose therapist has, it’s the secret sauce that makes everything work. So whether you’re Alex Smith coming back to the NFL, or just trying to get rid of knee pain while you are running, the skill and passion of your physical therapist helping you to heal in the right environment is the key to a speedy recovery.