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 that are athletic and active.
During the summer months the chances of getting a sprained ankle are even more common, so we wanted to share with you seven facts to keep in mind this summer if your little one happens to get a sprained ankle.
Before we jump into these seven facts, let’s start with a little background and what is a sprain and which age group is most common to get sprains.
What are sprains injuries?
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 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.
Now that you have a little more background on what a sprain is and the likelihood of It happening let’s get into to our seven things you should know about sprains.
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 over the inside of the ankle or the foot
Deformity of the ankle or foot
How are ankle sprains diagnosed in a child?
Ankle sprains are diagnosed and graded based upon physical findings and functional loss from grade I – grade III:
A grade I sprain: The child or young adult will have mild swelling and tenderness without joint instability on examination, and 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.
A grade II sprain: is 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.
A grade III sprain: involves a complete tear of a ligament. The child or young adult will have severe pain, swelling, tenderness, and bruising. If there is significant mechanical instability on the exam 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 RICE (rest, ice, compression, elevation) method for the first two to three days.
Rest is achieved by limiting weight-bearing. Patients use crutches until they can walk with 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 is improved, 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 further. Nonsteroidal anti-inflammatory drugs (NSAIDs) can be used to help with pain and swelling.
What shouldn’t I do?
In the first two to three days after your child’s injury, avoid the following:
Massaging this may potentially promote blood flow and make the swelling worse.
Heat (e.g., heat packs or hot baths) may increase blood flow and make the swelling worse.
Re-injury protect the ankle joint from re-injury by keeping weight off it and moving carefully.
When should 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 treat an ankle sprain, but especially the first one, seriously. 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. 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, to 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 reinjury, 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 reinjury is more significant with high ankle sprains 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 reinjury.
When can my child start walking without crutches?
Depending on the degree of the ankle sprain, healing times may vary. If the ankle sprain is minor, recovery can take place within two to three weeks. With more severe ankle sprains, the healing time can take six to eight weeks for a full recovery.
Here at Pediatrix Urgent Care, we have on-site x-ray and convenient hours which makes it easy to have these injuries evaluated promptly. Our hours of operation during the weekdays are from 4 p.m.- midnight and from noon till midnight on weekends.
The last thing you want when your child needs immediate medical attention is to spend considerable time searching for the right place to go. With 13 pediatric urgent care locations, Pediatrix Urgent Care of Florida is ready to meet to all your medical needs. Reserve a Spot Now.
Dr. Ayodeji Otegbeye
About the Author:
Dr. Ayodeji Otegbeye, better known as “Dr. O” is the President and Founder of Central Florida Pediatrics Intensive Care Specialists and Night Lite Pediatrics Urgent Care. Dr. O was the Medical Director of Children’s Medical Services in the Central Florida Region (Orange, Seminole, Osceola and Brevard Counties) from 2004 – 2019; and the Medical Director of Leesburg Regional Hospital Pediatric Hospitalist Program.
Disclaimer: These articles are not intended to be used for diagnosis or treatment. It is aimed at presenting a perspective only and is not a substitute for a prescription. Anyone experiencing a medical condition should consult their doctor.