What should I expect whilst recovering from tibia break?

[lizzypizz]

my 6 yr old daughter broke her tibia 9 weeks ago about half way down the bone. It was a spiral fracture but did not require surgery. She had her plaster removed last week, and we were simply sent away with a six week appt to "make sure she's walking properly". I would have expected some physio or advice at least about what to expect. As it stands, she is just about bearing weight on the affected leg, but is limping badly. Her ankle is puffy and stiff compared to her "good leg". The bad leg is often a different colour and cooler to the touch than the other. I did take her to the local hospital out patients and they checked her circulation and said that thats ok. Is it normal for the colouration and temperature to be different?

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[gcoe]

Hi Lizzypizz

Sounds a bit primitive management wise! the good news is the dismissal means things are probably all ok on the bone mending side. However I think some supportive physio to encourage her to get going is a reasonable request.

Yes discolouration, swelling and temperature changes are normal after immobilisation. However this will be a transient thing and should get better slowly over time with resumption of normal use. The part of the nervous system that controls the quality of circulation in the limb - the autonomic nervous system - is often not ticking over like normal. And the muscles like the calf and thigh muscles that are normally working during walking pump the blood back to the heart - so immobilisation results in fluid pooling in the foot/ankle. With normal stimulation of walking this resolves. If it persists she develops a lot of swelling or becomes acutely painful then go and get help. But otherwise, not to worry. In the mean time a tubigrip sock can help with the circulation.


the limping is not great but it is good she is putting some weight through the limb. Is she limping because it is painful or is she avoidant/scared of weight bearing? (often a mixture of both). Fear is quite a common reaction to a leg fracture and the best way to deal with that is with supportive encouragement and practice to build up her confidence.

Interestingly the area of the motor cortex in the brain that controls leg movement- one of the main control centres for complex movement - actually goes through a deterioration during immobilisation - the synapses between cells drops off - this is all temporary of course and we can get it all back by usage of the limb. It just goes to show what a necessary evil immobilisation is - it might be good for bones but not for our nervous system! I am just saying that not to scare you but just to point out what a big deal it is getting going again after an immobilisation and it is ridiculous expecting chidren just to stand up and walk normally as soon as the cast is removed.

BTW does your daughter like the water? Swimming, walking and aquajogging in the pool can be a fun and helpful medium to exercise in - even before she is weight bearing normally. a nice warm pool is needed especially as you are in winter.

Personally I also think it is reasonable for your daughter to have a strengthening programme - this is often neglected following immobilisation and it is true that children do bounce back anyway without specific interventions. But as the muscles will have lost considerable strength it makes sense to me to do this. She could also have her ankle/foot joint mobility checked.

[lizzypizz]

Thank you so much for your comforting and comprehensive reply. Its put my mind at rest for sure. I've been trying to get my daughter to circle her ankle to re-mobilse it somewhat, and making sure she bends her knee as much as possible. The limping is from fear. She has no pain, and is walking very straight legged. Since her plaster was removed she's become very attached to her zimmer frame. There's no doubt she feels very unstable and lop-sided. Thanks again for your fabulous imformative reply