Ankle Injuries: When Is It Time to Call the Doctor?

Your child comes home from a game, practice or the playground and is limping and complaining about ankle pain. Could something be sprained, strained or — even worse — broken?

It’s very possible. After about age 6, these injuries become much more likely as children start playing sports and becoming more active.

Soccer or basketball, or even just jumping off a moving swing at the playground, can cause an ankle sprain or fracture. And the constant use of certain muscles can cause painful strains. So how do you tell the difference between a strain, sprain or a fracture? 

It’s best for parents to decide if the injury needs medical attention, says foot and ankle surgeon Alan Davis, MD, who also specializes in sports health.

Common ankle injuries

The most common ankle injuries for children are:

1. Growth plate injuries — Growth plates are areas of cartilage located near the ends of bones. They are the last portion of a child’s bones to harden, and so are particularly vulnerable to injury in the growing skeleton.
2. Strains — overstretched or torn muscles. Strains can happen after trauma, such as overexertion or not warming up properly. They also can be caused by repetitive overuse.
3. Fractures — broken bones. Most fractures happen during sports when a player rolls or twists an ankle on an uneven surface, such as when stepping into a hole or onto another player’s foot. A player also may be hit directly by another player or run into an immovable object like a goalpost. Sometimes it happens when a player changes direction too quickly or sharply, rotating the ankle abnormally. In addition to trauma, repetitive overuse also can cause broken bones called stress fractures.

How do you tell the difference between a broken or sprained ankle? 

Figuring out whether an ankle is broken or sprained isn’t always easy to tell. The most obvious symptoms — bruising, pain and swelling — are shared by both injuries. X-rays may be needed to get an accurate diagnosis. 

However, there are a few ways to help determine whether you’re dealing with a break or a sprain. Here’s what to consider: 

• If the ankle looks crooked or otherwise out of line, odds are it’s broken.
• Is the pain centered on the bone or softer tissue around the ankle? If it’s on the bone, a break seems more likely. Sprains usually bring an “Ow!” factor to the meatier areas. 
• When the injury happened, was there a cracking noise? That’s an indicator of a possible break. Sprains may come with a popping noise or no sound at all.
• If the pain seems to be worsening, signs point to a sprain. A broken ankle typically comes with immediate pain before growing numb or tingly. 

“Unless you know anatomy, it’s usually difficult to differentiate between a sprain, strain and fracture,” Dr. Davis says. “It’s more important for parents to know how urgently an injury needs physician attention, if at all.”

When your child needs to see a doctor

According to Dr. Davis, your child’s ankle injury needs a doctor’s attention if there is:

• Significant swelling.
• Bone misalignment.
• Severe pain not resolved with rest.
• Marked tenderness to the touch.
• Your child can’t walk, move their ankle or put weight on it.
• There’s a change in your child’s skin color (the ankle or foot is turning blue).
• Numbness.
• Bleeding or a break in the skin.

Dr. Davis says to make sure to check the foot for any tenderness even though your child may be reporting ankle pain.

“These are signs of a serious injury that require immediate treatment,” Dr. Davis says. “Your child may need a splint, brace, boot or cast. If there’s significant damage or risk of damage to the growth plate, surgery may be necessary.”

Ankle injuries that don’t require medical attention

If the pain is not severe, there is a full range of ankle motion, normal strength, sensation and no misalignment, there is no reason to rush to a doctor, Dr. Davis says.

First, treat the injury at home with the RICE method:

Rest – Just as it sounds. Stay off the injured ankle to prevent more damage. (Want to keep working out? Use the injury as an opportunity to build muscle in other areas of your body.)
Ice – Apply a cold pack or ice bag (in a towel) for up to 20 minutes to reduce swelling and ease pain. Repeat four to eight times a day.
Compression – Wrap the ankle with an elastic bandage or compression wrap to help reduce swelling.
Elevation –​ Keep the ankle raised by resting it on a pillow or other elevated surface above heart level to reduce swelling and pain.

“If symptoms get worse, then call your doctor,” Dr. Davis says.

How to prevent an ankle injury

The best way to help your child avoid ankle injury is with proper physical conditioning for the sport. That includes:

• Having good flexibility, balance and endurance.
• Warming up before activity.
• Getting enough rest.
• Staying hydrated.
• Eating properly before practices and games.

Wearing appropriate shoes also is important, Dr. Davis says.

“Not all athletic shoes are the same,” Dr. Davis says. “The right shoe depends on your child’s sport with its specific demands, along with your child’s individual foot structure, such as arch height. Shoes always should be fit for sport by an experienced professional. Take your child to a running shoe store where professionals can help with fitting.”

Wraps and braces usually are not necessary for young athletes who are properly conditioned and have no previous injury, Dr. Davis says.