| Phase 1: Cross training and symptomatic treatment (typical duration: 1 week) |
- Wear long air splint for stress fracture of proximal and middle third of fibula; short air splint may suffice for distal fibula
- Wear air splint continuously while awake; remove for sleep
- Apply ice to fracture site 2 to 3 times daily for 10 to 20 minutes for as long as swelling persists; may apply after activity
- Take calcium 1500 mg and vitamin D 800 IU supplementation daily throughout rehabilitation
- Cross train with stationary cycling or swimming as tolerated up to 45 minutes daily
- Perform heel raises and squats with weight every other day; use approximately 25 to 30% of body weight; perform 3 sets of 15 repetitions for each exercise
- Progress to Phase 2 if able to jog, while wearing air splint, without limp or pain
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| Phase 2: Initiation of weight-bearing activity (typical duration: 3 weeks) |
- Use air splint for all activity
- Begin walk/run program: Run for 4 minutes then walk for 1 minute for 20 minutes total during week 1; 4 sessions per week maximum; do not repeat on single day
- Cross train on stationary cycle to complete 45 minutes total training daily
- During week 2, increase total walk/run to 25 minutes during each session with 5 sessions per week maximum
- During week 3, increase total walk/run time to 30 minutes during each session with 6 sessions per week maximum
- Continue strength training exercises as in Phase 1 on non-running days
- Apply ice to fracture site for 10 to 20 minutes after each training session
- Progress to Phase 3 if able to run continuously, without air splint, for 10 minutes without limp or pain; patient may use a compression sleeve or taping if this makes running more comfortable, but if unable to run without an air splint because of pain, the patient should continue Phase 2 for an additional week
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| Phase 3: Weaning from air splint (typical duration: 2 weeks) |
- Week 1 – Begin advanced walk/run program:
- Start by running 10 minutes then walking 2 minutes for 22 minutes total (1 session); perform 1 session each day for 2 days
- Progress to running 12 minutes then walking 2 minutes for 26 minutes total (1 session); perform 1 session each day for 2 days
- Progress to running 15 minutes then walking 2 minutes for 32 minutes total (1 session); perform 1 session each day for 2 days. Rest 1 day.
- Week 2 – Perform 3 sessions (1 session per day) of 25 minutes of continuous running followed by 3 sessions (1 session per day) of 30 minutes of continuous running
- If progressive running is tolerated without limp or pain, patient may progress gradually to normal training
- Apply ice to fracture site for 10 to 20 minutes after each training session
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