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Ankle sprains are one of the most common injuries in children. Ankles are made up of three bones with ligaments (tough, stretchy tissue which hold the bones together). The ligaments help stop the ankle joint from moving around too much.
Ankle sprains usually happen when there is a sudden movement or twist, and often when the foot rolls over. A sudden movement or twist can overstretch the ligaments, causing tears and bleeding (which shows as bruising and swelling) around the ankle joint. These movements are more likely to happen when a person is running, jumping or quickly changing direction in sports such as basketball, netball or football.
Signs and symptoms of ankle sprains include:
Treatment is based on First Aid principles. It should start immediately and continue for the next two to three days. Using the Rest, Ice, Compression, Elevation (RICE) strategy will help.
Rest the injured area and avoid activities that cause a lot of pain. If your child is having difficulty walking, crutches should be used.
Apply ice to the injured area for 10-15 minutes. Never place the ice directly on the skin because it can burn the skin. You should always wrap the ice or icepack in a teatowel or a pillow case. Do this every two to four hours for two to three days, when your child is awake. An ice pack is best made using a plastic bag with some ice and water in it. This moulds better to the ankle joint area.
Use a firm bandage that is not too tight and does not stop circulation or cause extra pain. The bandage should cover from just above the ankle right down to the foot. Do not cover the toes.
Raise the ankle whenever possible to assist with reducing the swelling. For example, raise your child's injured leg and rest it on some pillows while they are watching TV, reading or resting.
Some children will need medicine to help with the pain. In most cases, paracetamol is enough. Anti-inflammatory medications may help, but these are not suitable for every child. Ask your health care professional for further advice. Always read and follow the instructions on the package for the appropriate dose of medication for your child.
In the first two to three days AVOID:
Encourage your child to gently exercise and stretch the ankle joint. This should begin almost immediately to minimise stiffness. Start with exercise 1 and progress to exercise 4. Your child may have some mild pain at first. If significant pain is experienced, further rest is required. Walking on the ankle should be encouraged after two to three days if the pain is bearable. Active movement will quicken the healing process.
Using the ankle and foot only, trace (in the air) the letters of the alphabet from A-Z.
Draw a circle in the air with the affected foot.Repeat this 10 times.
Push the affected foot up and down 10 times.
With the knee straight, use a towel to gently pull the foot towards the face until a stretch is felt in the calf.
Hold this stretch for 30 seconds. Do this three times.
OR (b) Assisted calf stretchGet someone to help you. With the knee straight, and holding onto the foot, gently pull it towards the face. The child should feel a comfortable stretch in the calf.Hold for 30 seconds. Do this three times.
Remember - Recovery can start very early after injury. Following the principles of RICE and ankle exercises can help reduce your child's pain and swelling a lot, making it easier for them to walk again.
If the pain from a sprained ankle that you have been managing at home has not improved after a few days, it is best to seek medical advice from your doctor or physiotherapist. Either practitioner can examine your child's ankle, order an x-ray if needed and provide a management plan for your child's injury.You can expect your child to fully recover from most ankle sprains in one to two weeks. The length of time depends on your child's age, general health and the severity of the injury.
Developed by the RCH Dept of Emergency Medicine. First written May 2009. Updated May 2013.