PEDIATRIC FOOT OR ANKLE SPRAIN
PEDIATRIC FOOT OR ANKLE SPRAIN
MAY BE A MORE COMPLEX GROWTH PLATE INJURY
By: Robert H. Sheinberg, D.P.M., D.A.B.P.S., F.A.C.F.A.S.
X-rays can fail to provide a complete and accurate picture of the diagnosis.
Injuries to the growth plate in children may cause damage to the structures at the end of
the bone, which allow the child’s bone to grow to full adult size. These injuries may be
misdiagnosed as a simple sprain of the foot or ankle. However, a more complex injury
may be present.
Growth plates, which start to close between the ages of thirteen and eighteen can be
damaged in incidents such as simple falls, sports injuries, automobile accidents or other
major or minor trauma. If not recognized and treated early, a child’s growth plate injury
can lead to shortening of the bone (growth stops) as the growth plate may close
prematurely. Angular deformities of the bone (a curve) may also develop. The severity
of these deformities depends on the age at the time of injury, extent of the injury and the
part of the growth plate that has been damaged. Certain portions of the growth plate
may be injured affecting its growth while other parts grow more normally thus causing a
bowing of the bone.
Signs and symptoms of a growth plate injury may mimic a sprain. These injuries
occur more frequently than realized. There will always be pinpoint tenderness on the
bone’s growth plate and a degree of swelling that is proportional to the degree of injury
to the area. The child will often limp and try to avoid the body part. The injured body
part may often look deformed. Normal treatment for a sprain may involve simple
observation and application of an ace bandage or brace. This treatment for a growth
plate injury that is severe may be devastating.
X-rays are always taken to visualize the bone injury. In some cases the x-rays may be
negative. However, the tenderness that is felt by the patient is always indicative of a
simple fracture to the growth plate despite these negative x-ray findings. In more
moderate to severe cases the bone injury may be visualized. When in doubt a CT scan
may be needed to further evaluate the bone injury.
Treatment Options (early diagnosis is crucial):
1. Immobilization in a below-the-knee cast with or without crutches may be
necessary if the growth plate is well aligned. These injuries will heal on their own
within six to eight weeks. The younger the child, the faster the healing process.
2. If the injury has caused misalignment of the growth plate it can sometimes be
carefully manipulated back into place and then protected with a cast. The cast
would be necessary for a minimum of six to eight weeks. Nonweightbearing
would be mandatory for part of that time.
3. If the misalignment is more severe and not able to be manipulated back into its
normal position, surgery would be necessary to restore the growth plate to its
proper position. This may help avoid later problems including malalignment or
premature growth plate closure that may cause the extremity to be shortened
The most important thing is immediate diagnosis and treatment.