Ankle Sprain
Ankle sprains are one of the most common childhood injuries.
In these injuries, the ligaments become overstretched and it causes tears and bleeding. You will likely notice swelling and bruising around the ankle joint following these injuries. The bruising can take a few days to show up.
Symptoms
Initial treatment
Pain Relief
Weight Bearing
Symptoms
If your child has sprained their ankle you will likely see:
- Swelling that occurs in the first few minutes to hours after the injury. This swelling is caused by the body’s healing response to the soft tissue damage.
- Pain and tenderness around the ankle joint, and usually around the outside of the ankle.
- Bruising around the ankle joint, which can take up to 2-3 days to appear.
Initial treatment
If your child has sprained their ankle it is best to start treatment immediately following the principles of P.O.L.I.C.E (Protection, Optimal Loading, Ice, Compression, Elevation). This will help to reduce the swelling and aid healing.
Protection: It is important to protect the injured area to avoid further tissue damage. This may mean using crutches, a brace or tubigrip.
Optimal Loading: Optimal loading will enhance the healing process, and help to reduce swelling. For example, touch or partial weight bearing encourages the calf muscle to contract and therefore will minimise swelling at the affected ankle.
Ice: Use ice on the affected area for 10-15mins at a time, every 2-3 hours during the day. Make sure that you allow the ankle to return to normal temperature before reapplying an ice pack. Ensure you protect the skin from ice burns by keeping a barrier between your skin and the ice, like a tea towel or pillow case etc.
Compression: Compression bandages can be worn to help reduce the swelling, making sure that you can still wiggle your toes and the circulation is still intact.
Elevation: When resting keep your ankle elevated on pillows so that it is higher than the rest of your leg. This enables gravity to help with reducing the swelling.
Pain Relief
It is normal to experience mild pain and some children will require pain relief like Paracetamol or anti-inflammatories such as ibuprofen.
See NHS 111 Wales guidelines here on pain relief.
You can also seek advice from your local pharmacy.
Weight Bearing
If you attended trauma clinic, you may be given a walking aid (such as crutches or a frame) to help you walk. It is important to put weight though your ankle as this will help it heal effectively.
For further information on using walking aids, please click here.
Within a few days you should be able to start walking on your ankle normally. Slowly increase your distance each day and allow pain to guide you, as long as it is manageable to walk on your ankle it is okay to do so.
Exercises
Range of Movement Exercises
It is important to encourage your child to gently exercise and stretch the ankle. These exercises can be started from the day of your injury. Keeping your ankle moving will help speed up the healing process, avoiding stiffness and helping to reduce the swelling.
Try to complete these exercises 5 times daily and you can ice your ankle after completing.
- Point your toes up to the ceiling
- Point your toes down to the floor
- Trace the alphabet with your toes
- Turn your feet in so the soles of your feet face each other
- Turn your feet out so the soles of your feet face away from each other
You may need someone to help you complete the exercises to start with, but over time they should become easier to complete independently.
Proprioception (balance) exercises
Try to complete the following exercises once your physiotherapist has advised it is appropriate to do so;
Weight transfers:
Stand in front of a mirror and try to make sure you are taking an equal amount of weight on your left and right leg. Use the mirror to see if you are leaning to one side. Once you are comfortable doing this, progress to shifting your weight from side to side. If you need to, hold on to a sturdy surface when doing this to keep your balance.
Tandem walking
- Imagine you are walking on a tightrope.
- Place the heel of one foot in front of the toes of your other foot.
- Continue repeating this and walk forwards.
Single leg stand
- Try standing on your injured leg.
- Balance.
- Try and keep your balance for 30 seconds.
- Have a sturdy surface near by that you can use to steady yourself if you lose your balance.
Strengthening exercises
Once you can stand and fully weight bear on your injured ankle without increased pain and swelling you should be able to progress to strengthening exercises. Try these exercises below, however if they cause increase pain and swelling then rest a little longer and continue when you feel able.
Complete these exercises 10 times, once or twice a day for 2-4 weeks. You can use resistance bands or the opposite foot to add resistance to the exercises.
Push up toes
- Stand tall and slowly push up onto your toes, raising your heels.
- Hold for 3-5 seconds and slowly lower.
- Repeat 10 times.
Lift against resistance
- Loop foot within a latex resistance band or a tightly held rolled up towel
- Lift your foot up against resistance.
- Hold for 3-5 seconds and slowly lower back down.
- Repeat 10 times.
Turn foot against resistance
- Loop foot within a latex resistance band or a tightly held rolled up towel
- Slowly turn your foot inwards against resistance.
- At the end of the movement hold for 3-5 seconds and then slowly return to the starting position.
- Repeat 10 times.
Turn foot against resistance
- Loop foot within a latex resistance band or a tightly held rolled up towel and hold tight with the other foot.
- Slowly turn your foot outwards against resistance.
- At the end of the movement hold for 3-5 seconds and then slowly return to the starting position.
- Repeat 10 times.
The ankle is made up of bones and strong ligaments that hold the bones together. The ligaments help give the ankle stability.
Ankle sprains often happen when you go over on your ankle, with a sudden movement or twisting action.
For further advice and guidance call Dolphin Physiotherapy Outpatients on 029 218 47577
Noah’s Ark Children’s Hospital of Wales
Heath Park
Cardiff
CF14 4XW
If you have any concerns or queries about your child’s recovery please contact Dolphin Outpatients on 02921 847577.
If you child does not have an appointment arranged with physio and symptoms continue or are not improving gradually, then you can self-refer your child to the Paediatric physiotherapy outpatient department by telephoning our referral line on 02921836908.
