A child rolls an ankle during soccer, lands awkwardly after a basketball rebound, or steps off a curb and immediately develops pain. It is easy to assume the injury is “just a sprain.” While ankle sprains are common in active children and teens, an injury that looks like a sprain can sometimes be a fracture or an injury involving one of the growth plates.
That distinction matters because children’s bones are still developing. An ankle injury that causes a ligament sprain in an adult may affect a growth plate in a younger athlete. For parents, it can be difficult to tell the difference based on symptoms alone because both injuries can cause pain and swelling, bruising, tenderness, and difficulty walking. Understanding the different types of ankle injuries in children, how to recognize when an injury may be more than a sprain, when imaging may be appropriate, and when to seek pediatric orthopedic care can help ensure that a child receives the right diagnosis and treatment.
How Do I Know What Type of Ankle Injury My Child Has?
An ankle sprain occurs when one or more of the ligaments surrounding the ankle joint are stretched or torn. Ligaments are strong bands of tissue that connect bones and help stabilize joints. Ankle sprains occur most often when the foot suddenly twists or rolls beyond its normal position. This can happen when a child lands awkwardly after jumping, changes direction quickly during sports, steps on another athlete’s foot, or runs on an uneven surface.
Common signs of an ankle sprain include:
- Pain around the ankle
- Swelling
- Bruising
- Tenderness
- Difficulty putting weight on the injured foot
- Reduced range of motion
- A feeling that the ankle is weak or unstable
The severity of symptoms can vary considerably. A mild sprain may cause soreness and swelling while still allowing a child to walk. A more significant sprain can make weight-bearing difficult and cause substantial swelling or bruising. However, symptoms alone cannot always determine whether a child has injured a ligament or a bone. That is where evaluating pediatric ankle injuries becomes particularly important.
Is It an Ankle Sprain, Fracture, or Growth Plate Injury?
One of the most common questions parents have after an ankle injury is whether the ankle is sprained or fractured. A fracture and a broken bone mean the same thing, and both fractures and sprains can occur after a twisting or rolling injury. Unfortunately, there is not always an obvious difference based on appearance.
Both an ankle sprain and fracture may cause:
- Pain
- Swelling
- Bruising
- Tenderness
- Difficulty walking or bearing weight
Certain signs may raise greater concern for a fracture, including an obvious deformity, inability to stand or walk, or significant tenderness directly over a bone or growth plate. The location of the pain is particularly important when evaluating an ankle injury in a child. A healthcare provider will examine where the ankle is most tender and evaluate the bones, ligaments, swelling, stability, and ability to bear weight. When there is concern for a fracture or growth plate injury, imaging may be needed to determine what has been injured.
How Growth Plates Affect Ankle Injuries in Children
One of the most important differences between ankle injuries in children and adults is the presence of open growth plates. Growth plates, also called physes, are areas of developing cartilage near the ends of children’s long bones. Around the ankle, important growth plates are located near the ends of the tibia and fibula. Because children are still growing, the growth plates around the ankle can be injured during a fall, twist, or sports-related injury.
Growth plate injuries and ankle sprains can also cause similar symptoms, including tenderness, pain and swelling, bruising, and difficulty bearing weight. Because it may be difficult for parents to tell what type of injury has occurred based on symptoms alone, an evaluation may be appropriate when pain is significant or symptoms are not improving as expected.
Growth plate injuries require appropriate diagnosis because these areas help guide the future length and shape of a child’s bones. Treatment depends on the type and severity of the injury and may involve a brace, walking boot, cast, or, in more complex cases, surgery. Even teenagers who appear nearly fully grown may still have open or partially closing growth plates, so age alone should not be used to assume an injury is simply a sprain.
When Should a Child Get an X-Ray for an Ankle Injury?
Not every child who rolls an ankle needs an X-ray. The decision to obtain imaging depends on how the injury occurred, the child’s symptoms, where the ankle is tender, and findings from the physical examination. An X-ray may be appropriate when there is concern about a fracture or growth plate injury.
Signs that warrant medical evaluation include:
- Inability to bear weight or walk after the injury
- Significant swelling or bruising
- Tenderness directly over a bone or growth plate
- Visible deformity or abnormal position of the ankle joint
- Significant or worsening pain
- Symptoms that do not improve as expected
X-rays can help identify fractures and other bone injuries that may not be apparent from symptoms alone. A pediatric orthopedic specialist also understands the normal appearance of growth plates on X-rays and how that appearance changes as children mature. In some situations, additional imaging may be necessary if symptoms and the physical examination suggest an injury that is not adequately explained by the initial X-rays.
How are Ankle Injuries in Children Treated?
Treatment for a pediatric ankle injury depends on what structures are injured, the severity of the injury, the child’s symptoms, and whether a fracture or growth plate is involved. For a mild ankle sprain, initial treatment may include activity modification and measures to help reduce swelling and discomfort. Parents are often familiar with the approach of rest, ice, compression and elevation.
Depending on the injury, treatment may also include:
- Temporary rest from sports and aggravating activities
- Ice to help with discomfort and swelling
- Compression
- Elevation
- An ankle brace or walking boot to support the ankle
- Anti inflammatory measures when appropriate
- Physical therapy
- Strengthening and balance exercises
A brace or boot may be recommended to protect and stabilize the ankle while injured tissues heal. More significant injuries, including certain fractures or growth plate injuries, may require additional immobilization or other treatment. Once the initial pain and swelling improve, rehabilitation may become important, depending on the injury. Physical therapy may focus on restoring range of motion, strength, balance, flexibility, and ankle stability.
This rehabilitation should not be overlooked. An ankle that feels “better” may not yet have regained the strength and balance needed for sports. Incomplete recovery can contribute to repeated sprains and chronic ankle instability.
How Long Does a Pediatric Ankle Injury Take to Heal?
There is no single recovery timeline for every pediatric ankle injury. Healing depends on the type and severity of the injury, the child’s age, whether there are associated injuries, and how the ankle responds to treatment. A mild sprain may improve relatively quickly, while a more significant sprain, fracture, or growth plate injury may require a longer period of protection and recovery.
The goal should not be to return a child to sports by a particular date simply because an important game or tournament is approaching. Instead, recovery should be based on how the ankle is functioning. Pain and swelling should improve, and the child should regain appropriate range of motion, strength, balance, and stability. The child should also be able to walk and perform progressively more demanding activities without pain or instability.
If symptoms are not improving as expected, the ankle should be reevaluated. Persistent symptoms could indicate a more significant ligament injury, an unrecognized fracture, a growth plate injury, or another problem requiring treatment.
When Can My Child Return to Sports After an Ankle Injury?
Children should not return to sports simply because they can walk without pain. Running, jumping, cutting, landing, and changing direction place much greater demands on the ankle than normal walking. Returning before the ankle has adequately recovered may increase the risk of another ankle injury.
Before returning to sports, a young athlete should generally demonstrate appropriate:
- Pain-free movement
- Range of motion
- Strength
- Balance
- Ankle stability
- Ability to run, jump, and perform sport-specific movements without pain or instability
Balance can be particularly important following an ankle sprain. Comparing the child’s ability to balance and perform functional movements on the injured side with the uninjured side can help determine whether the ankle is ready for athletic demands. Some athletes may temporarily use an ankle brace when they return to sports to provide additional support. A physician, physical therapist, or athletic trainer can advise whether bracing is appropriate and when it can be discontinued.
A gradual return is preferable to immediately resuming full practices and competition. The goal is to help the athlete safely return while reducing the likelihood of reinjury or chronic instability.
When to See a Pediatric Orthopedist for an Ankle Injury
Parents do not need to determine on their own whether an injured ankle is sprained, fractured, or involves a growth plate. When symptoms are significant or are not improving as expected, an evaluation can help establish the correct diagnosis.
Consider seeing a pediatric orthopedic specialist if your child:
- Cannot bear weight or walk normally
- Has significant pain and swelling
- Has substantial bruising
- Has tenderness directly over a bone or growth plate
- Has an obvious deformity
- Continues to limp
- Has pain that persists or worsens despite rest
- Repeatedly sprains the same ankle
- Feels that the ankle gives way or is unstable
- Has difficulty returning to normal activities or sports
Pediatric ankle injuries deserve particular attention because children are still growing. A pediatric orthopedic specialist understands how developing bones and growth plates affect diagnosis, imaging, treatment, and recovery.
At The Pediatric Orthopedic Center, we evaluate and treat ankle sprains, fractures, growth plate injuries, sports injuries, and recurrent ankle instability with treatment plans designed for growing patients. Most ankle sprains and many other pediatric ankle injuries can be successfully treated without surgery. When appropriate, treatment may include immobilization, an ankle brace, activity modification, and physical therapy to restore strength, balance, and function.
Need Care for a New Ankle Injury?
Was your child’s ankle just injured at a game or practice? TPOC offers Pediatric Orthopedic Urgent Care in Cedar Knolls for new, non-life-threatening orthopedic injuries, including possible fractures, ligament sprains, and muscle or tendon strains.
No appointment is needed during walk-in hours:
Monday–Thursday, 5–8 p.m.
Saturday, 10 a.m.–2 p.m.
A pediatric fellowship-trained orthopedic surgeon will personally evaluate your child, with on-site X-rays and appropriate treatment, including bracing, splinting, or casting, available when needed. If you are unsure whether your child’s ankle injury qualifies for Urgent Care, call our front desk at (973) 538-7700 before coming in. For non-acute ankle injuries, call the same number to schedule an appointment during regular office hours.
If your child has injured their ankle and you are unsure whether it is more than “just a sprain,” an evaluation can help identify the injury and determine the appropriate treatment.
This article is for educational purposes only and is not intended to replace professional medical advice, diagnosis, or treatment. If your child has a severe, life-threatening, or limb-threatening injury, visit your local emergency room or call 911.
About Dr. Mark Solomon
Mark Solomon, DPM, is a board-certified foot and ankle specialist with extensive experience treating pediatric foot and ankle conditions and sports injuries. He is the founder and director of the Pediatric Foot & Ankle Fellowship at The Pediatric Orthopedic Center, helping train physicians in the specialized evaluation and treatment of foot and ankle conditions in growing children and adolescents.
