From the Research
Treatment of a distal fibula exostosis depends on whether it's causing symptoms, and if conservative measures fail, surgical excision may be recommended, as seen in a case series where distal fibular excision and reconstruction technique inspired by the original Tommy John procedure of the elbow allowed for long-term stability of the ankle and maintenance of full function 1. For asymptomatic exostoses, no treatment is necessary beyond regular monitoring. For painful exostoses, initial management includes:
- Activity modification
- Comfortable footwear with padding around the affected area
- Over-the-counter pain medications like ibuprofen (400-600mg three times daily) or naproxen (250-500mg twice daily) for pain and inflammation
- Possibly custom orthotics to reduce pressure on the growth Physical therapy may help with associated muscle imbalances. If conservative measures fail after 3-6 months or if the exostosis significantly interferes with function, surgical excision is recommended, with a procedure that involves removing the bony growth and is typically performed as outpatient surgery with a recovery period of 4-6 weeks 2. Exostoses form due to abnormal bone growth, often triggered by chronic irritation, trauma, or genetic factors. They consist of normal bone tissue growing in an abnormal location and pattern, creating a protrusion that can irritate surrounding soft tissues, particularly when wearing shoes or during activity. The management of distal fibula fractures, which can be associated with exostoses, depends on fracture type, displacement, and associated ankle instability, with conservative treatment leading to excellent results in simple, minimally displaced fractures without ankle instability 2. However, the most recent and highest quality study suggests that distal fibular excision and reconstruction technique can provide long-term stability and maintenance of full function, making it a viable option for the treatment of distal fibula exostosis 1.