An ankle sprain in children is a common skeletal injury that causes the ankle to roll or twist abnormally. The twist usually occurs when sudden movements cause the ligaments (tough, elastic tissues that hold the bones together) to overstretch and tear. It leads to pain and swelling around the ankle joint.
According to a meta-analysis conducted by Doherty Caibhe and others, children are at a higher risk of ankle sprains than teenagers. Also, children engaged in indoor or court sports have a higher incidence of ankle sprains (1).
Most minor or mild ankle sprains heal in about three to four weeks, but in case of a severe injury, it may take the ankle months to regain its original movement and strength. Medical intervention is necessary if the sprain causes more than slight pain and swelling.
Keep reading to know more about the possible causes of sprains in children and their symptoms and treatment.
Symptoms Of Ankle Sprains
Children might twist their ankles while playing or accidentally stepping on an uneven surface. If you see any of the following symptoms in your child, they might have an ankle sprain.
- Pain and swelling near the ankle joint
- Inability of the ankle to bear bodyweight and support walking
- Bruises that show up within two to three days
- Restricted range of motion
Based on the severity, ankle sprains are graded into the following:
- Grade I: It is associated with the stretching of the ligaments without tear and instability.
- Grade II: It refers to the partial tear of the ligament and mild instability of the joint.
- Grade III: It is a severe case wherein there is a complete tear of the ligaments with capsular injury and ankle instability (4).
Initial symptoms include swelling and pain near the ankle region. However, the symptoms can be worse based on the grade of the injury. Your child’s doctor is the best person to determine the grade and the extent of the damage. So, what could be the diagnosis for an ankle sprain? The next section covers this in detail.
Diagnosis Of Ankle Sprain
Your child’s doctor would do a physical examination to determine if it is a sprain or if any bones are fractured. They may also enquire about your child’s medical history and the nature of the accident.
In case the doctor suspects a severe sprain, the following diagnostic procedures might be recommended.
- X-rays to help understand the severity of the sprain and determine if there are any fractures to the bones
- MRI and CT scan to determine the extent of injury — these are generally reserved for chronic injuries and when the other procedures fail to give accurate results.
Ankle sprains can be quite painful, and recurrent ankle sprains may lead to chronic instability and pain in the ankle, with loss of function and degenerative changes of the ankle (4).
Let us now look at the treatment options available for ankle sprains in children.
Treatment For Ankle Sprain In Children
Treatment options may vary based on the type of ankle sprain and the severity of the symptoms. Initial management options may include any of the following.
- The RICE method
Rest: Restrict the movement of the ankle.
Ice: Apply an ice bag on the ankle for 15 to 20 minutes every few hours. Continue for two to three days.
Compression: If there are no broken bones, support the ankle with bandages or supports.
Elevation: Keep the ankle in an elevated position above the heart’s level to decrease the swelling.
- Your doctor might also prescribe pain relief medications, such as ibuprofen, to decrease swelling and pain.
- Physical therapy is also recommended to help your child restore ankle strength.
- Surgical interventions are considered when conservative treatment options do not work (4).
You can also take certain steps at home, in addition to the treatment prescribed by your doctor, and help relieve the symptoms of an ankle sprain.
Home Care For Ankle Sprains
Keep the following tips in mind while managing your child’s ankle sprain at home.
- Restrict the ankle’s movement for two to three days. Based on the severity of the injury, your child can also opt for crutches or ankle braces.
- Practice RICE diligently, as recommended by the doctor.
- Anecdotal evidence suggests that soaking your child’s ankle in a warm water bath with Epsom salt might soothe the sore joints and muscles. However, always consult your child’s doctor before using this remedy.
Next, let us look at some ankle exercises your child could do to help restore ankle strength.
Exercises For Ankle Sprains
Your child could start exercising the ankle as soon as their foot can bear weight and they are able to walk.
According to the Nationwide Children’s Hospital, the following strengthening exercises might help restore ankle use and ankle strength.
- Instruct your child to do toe raises by holding the toes on the edge of a staircase for ten seconds. The exercise should be done for ten to 12 minutes, twice daily.
- Ask your child to sit on the floor with legs stretched forward. Wrap a towel around the foot and push it down, up, and sideways while holding the ends of the towel.
- Ask your child to trace letters on sand or air using the ankle and the foot.
- Once your child is able to move the ankle and walk around with little pain, instruct them to stand on the sprained leg for 30 seconds while placing one hand on a table for support (5).
When To Call The Doctor?
Pain and swelling can be reduced with a few home care treatments; however, you need to call your doctor if you notice the below signs, as these could indicate a severe ankle injury.
- The pain and swelling increase.
- The foot becomes cold and numb.
- The recovery progress is not as expected.
- The ankle is tender to touch and changes color.
As ankle sprains are pretty common among children, are there ways to prevent them? Read on to find out.
Prevention Of Ankle Sprains In Children
Here are a few ways to prevent ankle sprains in children.
- Ensure your child does a proper warm-up before exercising or playing sports.
- Encourage them to exercise regularly to improve their joints’ strength and flexibility.
- Wear correct fitting shoes and avoid the use of heels to prevent ankle injuries.
Frequently Asked Questions
1. How do I know if my child has a sprain or a broken ankle?
If there is no sign of deformation of the ankle, and if your child cannot bear weight or use the ankle, it could most likely be a fracture. However, your doctor is the best person to determine if it is a sprain or a fracture.
2. Can ankle sprains happen again?
Although sprained ankles get resolved and do not generally cause any long-term damage, your child is likely to have an ankle injury again if they have loose joints or do not take precautions (6).
Ankle sprains are common among children. However, they can be painful and restrict their movement for some time. It is important to teach your children to exercise caution while playing and ensure they are exercising right to prevent ankle sprains.
2. Peter AA Struijs and Gino MMJ Kerkhoffs; Ankle sprain; BMJ Clin Evid. (2010).
3. Recovering from an ankle sprain; Harvard Health Publishing
4. Laura E Gill and Kevin E Klingele; Management of foot and ankle injuries in pediatric and adolescent athletes: a narrative review; Orthop Res Rev (2018)
5. Ankle Sprain; Nationwide Children’s Hospital
6. Ankle sprains; The Royal Children’s Hospital Melbourne
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