Ankle Sprains in Children

Ankle sprains are a common injury in life that are often associated with sports. While recovery from associated pain itself is largely uncomplicated, without treatment full recovery from ankle sprains can be complicated, leaving lasting problems. This is particularly an issue for children with their growing and developing bones and joints.

Sprains involve stretching the ligaments until fibers making up the ligament fray and are permanently stretched. The ligaments have difficulty guiding movement and protecting the joint after they are stretched and lax.

The ligaments contain proprioceptors and contribute to proprioception, or the sense of body positioning. When the ligaments are stretched, this sense of body position is altered. This can lead to the actual position of a joint or limb differing from the felt position. In the case of a lateral ankle sprain, this can result in the ankle inverting before the body is able to react and activate muscles to stabilize the ankle joint, resulting in subsequent repeated ankle sprains.

Chiropractic manipulation can be performed on an ankle early on if addressed quickly enough, helping to decrease pain, improving function, and aiding in recovery. There is a window of time soon after an ankle sprain before stiffness and inflammation build up where the ankle can be manipulated. This timeframe tends to be within 24 hours before stiffness, inflammation, and pain make manipulation impractical, but some may tolerate manipulation at later periods. Early manipulation helps to align the tissues and talus of the ankle with the joint, aiding recovery and allowing the ankle to heal straight.
With poor alignment during the healing process, the ankle joint can be prone to healing in the position it was sprained, resulting in increased movement and laxity towards that side. As the joint goes through the healing process, inflammation, swelling, stiffness, and pain build which can make manipulation less feasible. At this stage, manipulation may have to be postponed in favor of other modalities until pain has improved.

Rest, ice, compression, and elevation describes a treatment protocol for acute ankle injuries that helps manage pain and inflammation. This procedure is important early on in order to prevent excess inflammation as the healing process gets started.
Passive and active range of motion exercises can be performed as the initial acute inflammation begins to improve. Passive range of motion exercises may include gently moving the foot and ankle by hand. Active range of motions exercises include having the injured patient move the foot on their own. Often this is done by drawing the letters of the alphabet with the foot.

Growing children are developing their whole bodies, including their nervous system. Ankle sprains, particularly more severe sprains, can result in changes in body positioning, movement, and muscle activation called compensations. These compensations are not biomechanically optimal and place the body under increased strain and stress, and are particularly problematic in a child whose bones are growing and joints developing.
Proprioceptive exercises and stretches can be done to improve joint function after an exercise. The body is able to learn the new position of the ankle and compensate for laxity after an ankle sprain. However, it can be surprisingly difficult to re-establish good joint proprioception without focused exercises despite the apparent return of joint function when observed from a distance. Our case of repeated ankle inversion sprains is an example, where the ability to walk returns, but the ankle is still vulnerable to further sprains due to loss of proprioception. Common proprioceptive exercises include balancing on the ankle. These exercises are added when acute inflammation has improved and the patient is better able to stand on the ankle. When balance is improving, challenges can be incorporated to increase difficulty. Some challenges may include balancing on a less stable surface such as a foam board, or balancing with the eyes closed.

Ankle sprains and injuries are common in auto accidents as well, particularly if the patient anticipates the impact and braces. Force can be applied to the ankle suddenly placing excess strain on the soft tissues of the ankle joint. It can be more difficulty to identify ankle sprains as a problem after an accident as auto accidents can cause diffuse injury throughout the body. More severe sprains can be difficult to differentiate from fractures, and it is important to have them evaluated by a physician such as your Chiropractor. Ankle sprains can share many symptoms with ankle fractures, including swelling, bruising, and difficulty walking. Difficulty walking is more strongly associated with ankle fractures than ankle sprains. With a sprained ankle, a patient may be able to initially place weight on the foot, with walking becoming increasingly difficult as swelling and inflammation set in. Whereas with an ankle fracture a patient is more likely to not be able to place weight on the ankle and foot immediately following an injury. A fractured ankle needs to be addressed quickly in order to ensure proper bone alignment as the fracture heals. Knowing the benefits and importance of early treatment of ankle sprains, you can take the steps necessary to have the best outcome for your child in the event of an ankle sprain. Contact your Chiropractor quickly if you or your child have suffered an ankle sprain whether from sports or an accident.