Ankle Sprains

Ankle sprains are one of the most frequent presenting problems that we see in kids and adolescents.  The important thing is to recognize when you should take your child to be evaluated if they experience an ankle injury and also understand how to treat and rehab the injury at home.

First, like I've said before .... young kids don't sprain stuff.  What does that mean?  It means that their bones are the weakest link since their growth plates are still open, and that the growth plates get injured with a joint injury, not the ligaments.  You can "sprain" a ligament, not a bone.  Once a child's growth plate closes, they are more apt to truly sprain a joint.  Ligaments get "sprained," and muscles get "strained."

Ok, so your kid twists his ankle at soccer practice.  Should you run to the ER?  If the foot or ankle appears deformed or pale, yes.  That means there likely is a serious fracture.  If your child has immediate swelling in his ankle and can't bear weight, it is also important to be seen.  However, call your pediatrician first if it is after-hours and they can determine if it is ok to treat the injury at home overnight and be seen the next day.

Bottom line is that most ankle injuries in kids warrant an x-ray - especially if they are young enough where there growth plates in the ankle are still open (prior to puberty).  

If your child is diagnosed with a true ankle sprain (again, this is likely in adolescence), then there are several things you can do at home to speed along recovery.  You may have heard of RICE therapy.  This stands for rest, ice, compression (with a brace or ace bandage), and elevation.  This also works for ankle sprains.  Swelling in ankle sprains can be very impressive, and RICE therapy helps swelling go away faster (anti-inflammatories like ibuprofen can also help).  If your child cannot bear weight because of pain, they may need crutches for a couple days.

Kids are generally pretty good at letting pain guide them in terms of being able to bear weight on their ankle if they experience a sprain.  Once they are able to bear weight (when pain has improved), it is ok to progressively start to walk normally again.  If you rest the ankle too long with non-weightbearing that can lead to stiffness and more pain. 

Rehab is key to getting through an ankle sprain.  Rehab means moving the ankle, getting the strength back, and also getting back your balance.  This handout shows some great things you can do at home.  Remember, flexibility, strength, and balance are all part of rehab.  Sometimes ankle sprains are severe enough that it working with a physical therapist is required (you can be referred by your pediatrician or sports medicine doctor).  

Experiencing an ankle sprain is the biggest risk factor for having another one in the future.  A brace called an ASO (a lace-up ankle brace) is very helpful at preventing ankle sprains.  It is important to wear the brace during any cutting/pivoting sports.  Once you "stretch" the ligaments during an ankle sprain they never "tighten" back up - that's why wearing a brace is very important!  You can get a lace-up brace from your pediatrician or sports medicine doctor.  

Rachel Brewer, MD