Diagnosing and Treating Ankle Pain in Children

Podiatrists are experts at diagnosing and treating ankle pain in pain in children. Paediatric ankle and foot pain can be concerning for both the child and for their parents, however the team at Foot Centre Group and Pillar Health are here to provide solutions and treatments for ankle pain in children.

Why are my child’s ankles hurting?

The ankle is a complex structure which means that there are lots of possible causes of ankle pain in this region. When you visit a podiatrist they will ask specific questions and conduct specific tests to determine which structure or structures are contributing to your child’s pain.

Questions can include:

  • How old is your child?
  • How much activity are they doing/what activities are they doing?
  • When did the pain start?
  • How did the pain start?
  • What does the pain feel like?
  • When is the pain worse?
  • What makes the pain feel better or go away?
  • Does the pain keep you awake or wake you up?
  • On a scale of 1-10 how bad is your pain?

Together with musculoskeletal tests (eg. muscle strength tests, gait analysis and joint mobility tests) we are able to determine a diagnosis and establish a treatment plan. For more complex cases we may also use imaging (eg. x-ray, ultrasound or MRI) to help diagnose the cause of the pain.

Common causes of ankle pain in children include:

  • Growth Plate pain and Sever’s Disease (see below for more info!)
  • Ankle ligament sprains
  • Ankle fractures
  • Achilles Tendinopathies
  • Accessory bone pain
  • Plantar fasciitis

Growing Pains

Growing Pains in the ankle or heel are a very common cause of ankle pain in active growing children. This condition is commonly called Sever’s Disease, or more technically called Calcaneal Apophysitis. This condition often affected young, active children between the ages of 8 and 14 years old. It is most painful during or following periods of growth as the growth plate in the heel bone (calcaneus) becomes irritated and inflamed. The good news is that Calcaneal Apophysitis is a self limiting condition, meaning that once your child stops growing or their growth slows down, then their pain will subside. Until then your podiatrist will provide a management plan for your child to reduce their pain and meet their goals.

Can the pain be treated?

Yes! There are always options available to help manage your child’s pain. Treatment plans will depend on the cause of the pain for your child.

For growing pains, Calcaneal Apophysitis, common treatment includes:

  • Heel lifts to take the pressure off the heel when walking, running and during sports
  • Icing
  • Load management, during painful periods it is best to reduce your child’s activity levels in order to prevent their pain. Reduction in sports that involve a lot of jumping and running often causes the greatest alleviation in symptoms
  • Footwear changes may be necessary to increase the cushioning and padding under the heel and around the ankle whilst its sore
  • Gentle stretching can be used to lengthen muscles and reduce tension on the growth plate
  • Strengthening program can be developed to align with your child’s individual weaknesses

For acute ankle injuries, fractures and ankle sprains, common treatments include:

  • Offloading the area in the short term (eg. CAM boot, strapping, bracing)
  • Rest. Ice. Compression. Elevation.
  • Strengthen rehabilitation programs
  • Sport specific end stage rehabilitation programs to get back to sport

Should I be concerned if the pain worsens?

Increases in pain could indicate a new period of growth for your child and may not be an immediate concern. However, it is a good idea to book back in to see your podiatrist to rule out other possible causes of pain, especially if your child is already following their management plan. During the appointment the podiatrist may refer you to have some imaging done – this will likely be a bulk billed ultrasound and x-ray. However, if more detail is needed then they may refer you for an MRI.

For particularly complex conditions your podiatrist may work alongside your doctor and specialists to help diagnose and resolve your child’s pain.

How long will the ankle pain last? 

The duration of your child’s ankle pain is dependent on the diagnosis and a large variety of individual factors for your child. Each injury is unique and hence healing time is unique too. For growing pains, as this is a self limiting condition the pain will resolve once the child is past large periods of growth (often around the age of 15 years old). For fractures depending on the severity of the fracture this can take 4-8 weeks in a CAM boot followed by 1-3 months of strength and conditioning to return to sport. Ankle sprains are also dependent on the severity of the sprains and the extent of injury to ankle ligaments, typically the majority of symptoms should resolve in 2 weeks, although a 6-8 week rehabilitation program is recommended to prevent chronic ankle instability and reduce the risk of re-injury.

Can there be long-last effects? 

If each condition is managed appropriately and rehabilitated to the full extent then it is unlikely that there will be any long-term effects or long-lasting pain.

Can my child still play sports?

Depending on your child’s injury they may have to take some time out from sport – running and jumping on injuries such as fractures or acute ankle sprains can result in further pain, damage and chronic injury. However, once your child is fully rehabilitated they can make their full return to sport!

For growing pains, your child can still play sport if their pain levels are manageable, we recommend a maximum of 4/10 pain during and after activity. If your child is having pain greater than this then it is best that they reduce their sport load. However, we always recommend they participate in over ways such as scoring, assistant coaching and drills.

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