7 Things You Should Know About Ankle Sprains in Children

Pediatric ankle injuries are among the most common injuries presenting to primary care offices, pediatric urgent care centers and ERs. These events tend to occur when your physician’s office is closed and can be quite common for kids who are athletic and active.

During the summer months, the chance of getting a sprained ankle is even more common.

What are sprains?

Sprains are stretching, partial rupture or complete rupture of at least one ligament. Ankles consist of three bones held together by ligaments (tough, stretchy tissue). Ligaments help prevent the ankle joint from moving around too much.

It’s estimated that two million ankle sprains occur across the country every year, with almost half taking place during sports-related activities. Pediatric ankle sprains commonly happen in sports that require quickly changing directions and jumping, such as basketball, soccer, football, tennis and volleyball. Athletes at are at their highest risk between 10 and 19 years old.

When should I see a pediatric doctor for my ankle sprain?

Ankle sprains can lead to chronic pain and instability of the ankle if not adequately treated. A common misconception among parents is that an ankle sprain is a "mild injury that will heal on its own." Please don’t take that approach if your young athlete injures an ankle.

Most ankle sprains cause an injury to the outside portion of the ankle. However, an injury to the inside of the ankle can indicate a far more worrisome injury. If you think your child has an ankle sprain, it’s always best to have an examination by a physician. The fact that most sprains occur when your primary physician’s office is closed makes Pediatrix Urgent Care a cost- and time-efficient place to access initial evaluation and treatment for your child or young adult.

Some of the signs and symptoms of ankle injuries that would require evaluation include:

• Inability or difficulty bearing weight on the affected ankle
• Significant swelling or bruising anywhere on the ankle, leg or foot
• Pain on the inside of the ankle or the foot
• Deformity of the ankle or foot

How are ankle sprains diagnosed in children?

Ankle sprains are diagnosed and graded based on physical findings and functional loss from grade I to grade III:

Grade I sprain: The child or young adult will have mild swelling and tenderness without joint instability on examination. The patient can bear weight and move about with minimal pain. These injuries are not frequently seen in the office as they typically resolve without intervention.

Grade II sprain: A more severe injury involving an incomplete tear of a ligament. The child or young adult will have moderate pain, swelling, tenderness and bruising. There is some restriction of the range of motion and loss of function. Weight-bearing and movement are painful.

Grade III sprain: Involves a complete tear of a ligament. The child or young adult will have severe pain, swelling, tenderness and bruising. There is significant mechanical instability and considerable loss of function and motion. Patients are unable to bear weight or move.

It is estimated that fracture of the ankle or midfoot occurs in less than 15% of patients presenting to an ER with an acute ankle sprain. At Pediatrix Urgent Care, we can assess the need for X-ray studies, perform the X-ray and provide initial management of any associated fracture.

How are ankle sprains treated in a child or young adult?

Sprains and strains heal quite quickly in children and teens. Initial management goals are to limit inflammation and swelling and to maintain range of motion. Early treatment includes the RICE (rest, ice, compression, elevation) method for the first two to three days.

Rest is achieved by limiting weight-bearing movement. Patients will use crutches until they can walk at an average speed. Ice application or cold-water immersion is recommended for 15 to 20 minutes every 4 to 6 hours for the first 48 hours or until swelling improves, whichever comes first.

Compression with an elastic bandage to minimize swelling should be applied early. Patients with mild (grade I) ankle sprains do not require immobilization. Treatment with a stretchy wrap for a few days following the injury is sufficient. Patients with moderate (grade II or III) sprains usually need sustained support with an elastic wrap and an Aircast or similar splint. Stretchy wrap and braces can be provided at Pediatrix Urgent Care Centers. The injured ankle should be kept elevated above the level of the heart to alleviate any further swelling. Nonsteroidal anti-inflammatory drugs (NSAIDs) can help with pain and swelling.

What shouldn’t I do?

In the first two to three days after your child’s injury, avoid:

• Massaging the area, as this may promote blood flow and make swelling worse
• Applying heat (e.g., heat packs or hot baths), which may increase blood flow and make swelling worse
• Re-injurying the ankle. Be sure to keep weight off it and move carefully

When can I return to sports?

It is essential in all but mild cases for a medical doctor to evaluate the injured ankle and establish a treatment and rehabilitation plan. You and your child should take an ankle sprain seriously, especially the first one. An athlete who fails to allow an ankle sprain to heal properly is at risk for developing chronic ankle instability.

Rehabilitation is vital in aiding the return to activity and preventing chronic instability and recurrent injury. Recovery begins with exercises for mobility such as Achilles tendon stretch, foot circles and alphabet movements. Progression of the rehab exercises are beyond the scope of this blog but should be gradually advanced to include strength, balance and activity-specific training with progress from walk-jog to jog-run to run, and then run with the change of direction.

Your child needs to demonstrate psychological readiness to return to play. This is because athletes who show apprehension, fear or anxiety are at a much higher risk of re-injury, and their athletic performance is also likely to suffer.

If my child has had a severe ankle sprain, is it more likely that he/she will sprain it again? What can I do to prevent injuries and strains in my child?

The risk for re-injury is more significant in the first two months but can occur even after that. Make sure your child follows any activity restrictions and stretching and strengthening exercises to prevent re-injury.

When can my child start walking without crutches?

Healing times will vary depending on the severity of injury. If the ankle sprain is minor, recovery can take place within two to three weeks. With more severe ankle sprains, it can take six to eight weeks for a full recovery.

We have onsite X-ray capabilities and convenient hours to make it easy to have these injuries evaluated promptly. Reserve a Spot Now.