Child Foot and ankle injuries: When is it time to call the doctor?

For children, playing is as natural as breathing. As soon as kids can stand, they are dodging imaginary foes and winning races against invisible friends.

It’s a common scenario in many homes…….

Your child comes home after playing and has a limp and complains about pain near their foot or ankle. As a parent you immediately worry, could it be just a sprain, strain or — worse — broken?

Playing sports such as football or basketball — even just jumping off a moving swing at the playground — or running around can cause a sprain or fracture. Excessive use of certain muscles can cause painful strains. So how does one tell the difference between a strain, sprain or a fracture?

The foot has 26 bones and at least 19 major joints. In a child all these bones are still growing, joints and ligaments still maturing. The commonest injuries we see in children are:

Growth plate injuries and fractures / broken bones— 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 susceptible to injury within the growing skeleton.

• Sprains — Our joints are held together by a structure called a “ligament”. Any injury to a ligament is called a sprain
• Strains — overstretched or torn muscles.
• Overuse injuries — Excessive stress is placed on your joint or other tissue, often by “overdoing” an activity or repeating an equivalent activity over and over.

So “Unless you are well versed with the anatomy of the paediatric foot, it’s difficult to differentiate between sprains, strains and fracture in children,” but “It’s more important for folks to understand how urgent your child’s injury needs specialist attention, if at all.”

So When does your child need a doctor?

1. Significant swelling.
2. Bone misalignment or misshaped foot or ankle.
3. Severe pain not resolved with rest.
4. Your child can’t walk, move their ankle or put weight on it.
5. There’s a change in your child’s skin colour (the ankle or foot is turning blue).
6. Numbness.
7. Bleeding or a break in the skin.

“These are all signs of a serious injury that require immediate treatment,” Your child will need an x-ray or higher imaging and may need a splint, brace, boot or cast. If there’s a significant injury or damage to the growth plate, surgery could also be necessary.”

So what injuries don’t require urgent medical attention?

If the pain is not severe, there is a full range of ankle motion, no misalignment, there is no reason to rush to a doctor

All parents need to know the right first aid method to give their child. Know the simple RICE method:

• Rest – Just as it sounds. Stay off the injured ankle to stop more damage.
• Ice – Apply a cold pack or ice pack (in a towel) for up to twenty minutes to scale back the swelling and ease the pain. Repeat four to eight times each day.
• Compression – Wrap the ankle with a bandage or compression wrap to assist swelling reduction.
• Elevation –​ Keep the foot and ankle raised by resting it on a pillow or other elevated surface above heart level to reduce swelling and pain.

“avoid any massage with oils or solutions. If at any time symptoms get worse, then it’s time to seek help.

A common question we regularly get is How to prevent such injuries…

The best way to help your child avoid ankle injury is with proper physical conditioning for the sport and play. Encourage Warming up before activity. Getting enough rest. Staying hydrated. Eating properly and importantly Wearing appropriate footwear.

We at SRCC Children’s Hospital, managed by Narayana Health, give specialized care in all aspects of pediatric injuries, we have a team of doctors and nurses who treat children of all ages all the time and are there to make you and your child comfortable during this whole process.

Dr. Avi Shah | Consultant – Orthopaedics, Orthopedics-Paediatric | SRCC Children’s Hospital, Mumbai