My 8-year-old son is always running, jumping, or climbing on something. I am particularly worried about him slipping on ice. He has twisted his ankle this way before, and I have always been able to treat him at home with an ice pack and a children’s pain reliever. When should I be concerned that a sore ankle might be something more, and what are the signs that he needs to go to the emergency room?
Twisted ankles (or sprains) are a very common concern — and can cause much confusion — for many parents. Like you, they want to take the best care of their child without making unnecessary trips to the emergency room.
The rule of thumb for ankle injuries is watchful waiting. Should your son twist his ankle, keep a close eye on the affected area — some symptoms may appear immediately, others may develop over the next hour or two. It is important to pay attention to what he says he is feeling. If a few hours after treating your son with an ice pack and a Tylenol or ibuprofen he is not complaining of pain and feels well enough to play, it is unlikely that any medical attention is required.
However, if symptoms such as pain and swelling persist, you should be prepared take him to his pediatrician or an outpatient clinic or, in the case of a severe sprain, the emergency room.
Sprains are one of the most common types of ankle injuries. They occur when stress is placed on the ankle at an angle it cannot sustain, causing a stretching or tearing of the ligaments, the fibrous tissues that connect bones to each other. At the time of injury, a sprain may cause a popping sound, and cause swelling, bruising, and tenderness in the ankle to develop.
A sprain can range in severity from minor to major. Some ankle sprains just need rest to resolve; others may be very painful, with the ankle unable to bear weight. In cases in which the ligaments are badly torn, the ankle may have severe bruising, increased swelling, and be unable to bear weight without significant pain and may feel slightly unstable. In this case, immediate medical attention is needed, and depending on what facility is most accessible, possibly a visit to the emergency room.
With a physical examination and, almost surely, an X-ray, a physician will be able to determine the full extent of the injury and recommend the best course of treatment. Minor sprains can be treated using the RICE method to reduce swelling and pain:
• Rest the ankle
• Ice the area
• Compress the ankle with an ace bandage to keep it stable
• Elevate the ankle when sitting or lying down
These sprains will usually heal within a few weeks. More severe sprains may also require some physical therapy and/or the use of an elastic bandage or a cushioned plastic brace, or even the temporary use of crutches. These more serious sprains may require between six weeks and three months of recovery time.
Some of the symptoms of a sprained ankle, such as swelling and bruising, overlap with those of a fracture. There are some key ways to tell the two apart. A fracture, or breaking of a bone in the ankle, will cause a cracking sound rather than the pop associated with a sprain. Fractured ankles may also appear crooked or otherwise deformed after the event. Additionally, the pain will emanate from the bone itself rather than the area around it. In some cases a sprain and a fracture occur simultaneously. The X-ray will reveal the exact nature of the injury.
You may not be able to stop your son from jumping off tables or sliding on the ice, but you can be prepared to treat the consequences. With luck, they won’t require much more than some ice and a hug.
