FOOT AND ANKLE FRACTURES AND SPRAINS IN CHILDREN
Robert H. Sheinberg, DPM

Why are injuries common in children?

Competitive Sports are becoming a greater part of the lives of young families. There are more kids competing in multiple sports. Many improperly conditioned children are predisposed to injury.

What are the most common injuries?

Ankle growth plate injuries are the most common. During sports a tremendous amount of stress goes through the ankle. This is especially true in soccer and basketball.

How do injuries occur?

Injuries may occur from falls(skateboard,rollerblades), direct trauma(getting kicked), twisting motions(turning the foot under the ankle), repetitive motion(tendonitis) and overuse(stress fractures).

What makes injuries in children and teenagers different from adults?

Fractures and sprains in children result from relatively simple injuries, rather than complex mechanical forces that usually cause adult injuries. Injuries may involve specific growth regions(growth plates) of bone, causing disturbances of bone growth. Bone growth problems may not manifest themselves immediately.
Ligaments are looser in kids than adults. Also, they are more resistant to stress than growth plates. Henceforth, ligament injuries occur less often in kids than do growth plate injuries.
Bone remodeling in a growing child may in some cases realign a fracture that looks slightly out of place making absolute anatomic reductions less important in children than adults. HOWEVER, exact reduction should be attempted whenever possible.

How does a parent know if the injury is a medical emergency?

The extremity looks visually distorted or out of place compared to the uninjured side.
A fracture may be associated with a break in the skin. Bone may be sticking out(open fracture)
The foot and/or leg are turning very cold and the injured extremity is turning blue(circulation is being compromised)

Will my child need surgery?

Certain injuries are medical emergencies and will need operative intervention;
Significant displacement of the fracture-cannot be put into proper position without manipulation and casting.
Open Fractures(Bone sticking out through the skin)
Compartment Syndrome(Severe swelling)
Dislocations that cannot be reduced and/or cause nerve and arterial injuries.

What is the best treatment available?

Treatment involves a thorough history of the injury. Predisposing factors must be identified. X rays are taken to reveal the extent of the injury. Most minor injuries may be treated with rest, ice, compression, and elevation. More significant injuries may require a weight bearing or non-weightbearing(needs to have assistance of crutches) cast. Severe injuries may require surgery if conservative care does not or will not achieve an acceptable result. Delayed healing or non-healing(nonunion) of fractures is rare.

Do children heal quickly?

Are there any long-term concerns?

Growth plate injuries may cause disturbance of bone growth. Fractures of the leg may cause limb-length discrepancies. Most often it is less than 1/3 of an inch. We usually follow the child until skeletal maturity. The tendency to cease follow up care may result in subsequent presentation of significant growth deformities. Fractures into the ankle joints or the foot joints may cause arthritis in the joint as the child ages. This occurs most often if the joint fracture heals in poor alignment

How do we know if my child is OK to resume sports?

Your physician should check the injury and will inform you if the injury has healed. You will also notice that your child will have minimal disturbance of gait(no limping). Stiffness and pain are minimal. Always check for pinpoint tenderness as this is indicative of incomplete healing. Children often try to get back into sports too quickly after an injury. A gradual, guarded and sensible return to sports should be the rule.
How do we avoid injuries?
Certain children may be predisposed to injuries. Poorly aligned extremities(i.e. flat feet, extremely high-arched feet, bowlegs, knock-knees, in-toe or out-toe) should be evaluated prior to engaging in sports so that a child is not put at risk. Daily stretching of tight muscles and tendons to allow full range of motion at all lower extremity joints lessens the risk of injuries. Also, target training of any weak muscle groups is necessary to assure that all muscles groups are working in synchronicity. Proper shoe gear is important and if necessary, custom-molded in-shoe orthotics may be necessary to realign the feet and lower extremity. They will stabilize the foot and leg to allow for more activity and less chance of injury.