Your daughter twists her ankle playing soccer this weekend and says it hurts to walk on it. Your next thought is ‘is it broken?’. How can you tell? Do you need to be seen? What if it is broken?

My friends call and text me every few weeks with these exact questions. They text me a picture of their child’s ankle with an arrow where it hurts. What is the right thing to do in all of these situations? What concerns me as a orthopedic surgeon?

Kids sports injuries are different than an adult. Children are still growing and an injury to a growth plate could result in the inability for a bone to grow further or for it to grow improperly. When an injury occurs, there are a few simple steps to follow:

How to treat your kids sports injury

First, use ice, wrap it with an ACE wrap, and keep it elevated. This will help limit swelling and pain.
Next, stay off of it and don’t use it! If anything looks concerning to you go to the emergency room! Your child can use crutches (if old enough) and don’t bear weight for foot and ankle injuries. You can use ibuprofen or tylenol if the pain is hard to tolerate. Finally, plan on seeing your orthopedic surgeon to check it out if it doesn’t get better in the next few days. I always encourage you to use your parental intuition and be seen right away if you think it is right. For most sprains and strains and even simple fractures, there is not an emergent rush to be seen.
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How to determine if a bone is broken

There are three key parts: The story of how it happened is the place to start. I need to know what happened and what happened since. Next, if broken, affected area will be tender right over the growth plate. Finally, an x-ray may or MAY NOT show a fracture. MYykey point: a normal x-ray does not mean it is fine. The growth plate can be injured and the x-ray will look normal. Most orthopedic doctors don’t rely just on the x-ray to choose a treatment. If the bone is tender in the right spot, we assume a fracture is present the x-ray can’t detect. In all cases, the right treatment is to immobilize the area so it can heal. Get ready to pick your favorite cast color !!

How long do you need a cast?

Most children’s growth plate injuries heal quickly. I usually place my patients in a cast for 3-4 weeks and see them back to recheck the injury. If the pain is gone, the bone is healed ! If it still hurts, a little more time is needed.