Young Athlete Ankle Advice

by:  Kathleen Weaver, MD, FACS

Baseball, tennis, soccer, track, football, basketball: it's likely that the athletes taking part in these sports are younger than anytime in the past.  And all these activities have one important thing in common – ankle injury.  If you run, it is possible to injure your ankle.

First, let’s dispel some misconceptions:

“If you're able to walk upon it, then it isn’t broken.”  That is wrong.  If it hurts after an injury, then it might be fractured.  If the swelling, pain, or dysfunction persists, seek attention.

“It’s just a sprain; that's no big deal.”  Wrong again.  In fact, the long-term outcomes of some sprains are even worse than bone fractures!  A bad sprain which is not correctly treated can cause chronic instability of the joint and maybe early arthritis as well as other problems in the future.

The ankle is black and blue, but “it’s just a bruise.”  Do not be duped!  Discoloration of the epidermis is due to bleeding.  It might be superficial, but it might also be from deep injuries to the muscles, ligaments or bones.

Grabbed your attention?  Good!  Please read on …

If a young athlete is afflicted with an ankle injury, get him or her out of the game or practice.  Athletes, parents and coaches could be frustrated, but think about this: is the outcome of this little league competition worthy of the potential risk of ankle problems for the next 80 years?

First aid involves Rest, Ice, Compression, and Elevation (R.I.C.E.).  That should reduce inflammation and swelling.  The compression should be firm enough to provide some immobilization of the joint but not limit blood flow to the foot.  Minor injuries may respond to those measures, but any disfigurement, persistent swelling, persistent pain, recurrent pain, or sense of “giving way” of the joint ought to be examined by your physician.  Keep the ankle joint immobilized and elevated as much as possible until the patient can be seen.

No matter what kind of doctor sees the child (Emergency Department, Urgent Care Center, Family Doctor, or Pediatrician) there is one significant fact about children’s bones that you have to remember – children’s bones have “growth plates” around the ends.  There are two of these “growth plates” in each ankle joint.  They're weak places where fractures are normal.  A fracture at a “growth plate” can be INVISIBLE on x-ray.  A radiologist may interpret an x-ray as “normal” (and be completely right) even when there is a fracture present!  If your doctor is not familiar with children’s sports injuries, the individual can be tricked by the x-ray report and underestimate the injury.  The safest course for a youngster with localized tenderness over a bone “growth plate” is to identify and treat it like a fracture.  This may save weeks or maybe months of recovery time.

Just like the old song says, “…the ankle bone’s connected to the leg bone.”   An ankle injury could possibly be connected with knee joint, hip, or various other injuries.  Be sure that the evaluating physician is told about every place that hurts, regardless of if it appears minor at the time.

Finally, do not forget that healing the injury is just half the treatment.  All athletes, but especially growing children need thorough and complete rehabilitation before jumping back into their activity.  Much of the treatment can probably be done in your own home.

The ankle is a prevalent area of injury in young athletes.  Do not minimize a problem as “just a sprain” or “it’s OK because Junior can walk on it” – when in doubt, check it out.  The sports season is going to end at some point, but the child needs that ankle for all of his or her life.

About the author:

Kathleen Weaver, MD, FACS owns Audrain Orthopaedics in Mexico, MO.  She is certified by the American Board of Orthopaedic Surgery and finished Fellowship Training in Pediatric Orthopaedics at the Shriners Hospital for Crippled Children in Honolulu, HI.

Thank you for seeing me the day I walked into your office in such pain – I believe that there are angels among us & you were mine that day…

N.M age 59