Pediatric ankle injuries in young athletes are so prevalent, that we can almost predict what we’ll see at TPOC based on the time of year, sports season or even the day of the week (such as ankle injuries from playing on backyard trampolines over the weekend—with office visits on Monday).
Ankle injuries are the most common sports injuries in children and teens and have become seasonal along with school and recreational sports schedules. Most of these orthopedic injuries are from rolling or twisting the ankle, which results in bad sprains or fractures.
Seasonal Ankle Injuries
In the late fall (mid-November to mid-December) we see many pediatric ankle injuries among young basketball players. In fact, 46% of all basketball injuries are related to the ankle during this period. That’s because basketball involves a lot of lateral movement and jumping, which can put children at higher risk for ankle injuries. For instance, if the child lands on an opponent’s foot, this may cause their foot to twist or roll to the inside or outside.
March and July are peak periods for gymnastics competitions and when young gymnasts are learning new skills in anticipation of the season ahead. With increased gymnastic activity comes more pediatric ankle injuries. The same goes for cheerleading competition season.
The issue is exacerbated for youth athletes who play different sports year-round or in multiple seasons, such as lacrosse players or soccer players (fall season) who also play baseball (spring), or track & field athletes who may participate in their sports over three seasons (outdoors and indoors).
Scoliosis and When to Seek Medical Attention for a Pediatric Ankle Injury
The ankle is not one bone; rather, it is the joint where the tibia, fibula, and talus bones come together. They are joined by several ligaments that keep the ankle joint stable.
It can sometimes be difficult to discern if the sports injury is an ankle sprain or an ankle fracture. Here are signs you should bring your child in for an orthopedic evaluation:
- Difficulty walking or putting weight on the foot
- Swelling or bruising around the ankle
- Clicking or popping sound
- Deformity of the ankle joint
- Pain or other symptoms do not subside within two or three days
These acute ankle injuries can develop into chronic instability at the joint if left untreated. When the athlete has been removed from the field of play and cannot put weight on the ankle, they should be taken to an orthopedist for an X-ray and medical evaluation to determine the extent of injury and course of treatment.
Hazards and Treatment of Pediatric Ankle Injuries
In an adult, an ankle sprain or even a hairline fracture will heal by staying off the foot for a prescribed amount of time. However, in growing children, an ankle fracture can be more complex, with potential damage to the growth plates.
At TPOC, we recommend the child’s ankle be immobilized for about a week, after which time we re-evaluate the ankle injury and begin rehabilitation if warranted. Treatments include:
- CAM boot: A controlled ankle motion (CAM) boot avoids the use of crutches to make it easier to return to school (school districts see crutches as safety risks). The CAM boot protects the ankle from side-to-side motion that can aggravate the injury. It is removed only for sleep or bathing. We will do a follow-up exam after a week.
- Physical therapy: PT may be prescribed several times a week, a few times a day. We always tell parents that the more time and energy their child invests in PT, the faster the improvement.
- Cast: If the young athlete will not comply with wearing the CAM boot, we will put on an ankle cast. We will also apply a cast if, at the one-week follow-up exam, the child is still complaining of pain.
- Ankle surgery: Indicated in cases of a severe dislocation involving the growth plates, the cartilage at the end of long bones that harden into solid bone during adolescence. When the growth plate begins to close and harden in teenagers, transitional fractures of the maturing growth plate can occur. These must be surgically treated if there are more than 2 millimeters of dislocation. However, we prefer to avoid surgery, if possible, and will try 8-10 weeks of rehabilitation first.
- Lateral ankle stabilization: if the ankle does not respond to other therapies, we may perform this arthroscopic surgical technique, in which we make a small incision and tighten or recreate the ankle ligament structure. The patient starts to use an ankle brace for walking seven days after surgery and returns to physical therapy to promote healing and strength.
Returning to Play After and Ankle Injury
Our pediatric orthopedists strongly encourage coaches and trainers to be proactive in terms of conditioning programs to help youth athletes avoid ankle injuries. Proper warmups go a long way. Coaches and trainers are also instrumental in helping athletes comply with doctors’ orders about wearing the CAM boot, following through on physical therapy, and not returning to play until the orthopedist indicates it’s safe to do so.
At TPOC, we perform a balance exam to compare the child’s ability to balance on the injured leg with the other one. When the child can take forward and side hops without a problem. they are ready to return to play. This is usually in about four weeks. If the ankle had been fractured, we’ll take an X-ray to make sure the bones have healed properly. Parents should not be concerned about long-term bruising—common with the initial ankle injury—as this can take a few weeks to go away.
There are many exercises athletes can do as preventive measures, as well as part of a rehabilitation program following an ankle injury, such as those listed here. As with any pediatric orthopedic injury, early detection and treatment make all the difference in terms of positive outcomes.
