Swell Tips for Treating Ankle Sprains

Parents have been asking me some swell questions about what to do when their child’s ankle swells after an injury, and whether it might be sprained.  Well let me put my best foot forward and provide some information on this topic.

An ankle sprain is when the ligaments (a type of tissue that connects one bone in the ankle joint with another) get overly stretched and/or torn.  This need not just occur in an athletic event, but simply by stepping in a hole, tripping on stairs, or putting your weight down awkwardly.  Fortunately in younger children, ligaments may be stronger than the bones themselves – such that the bone is more apt to be injured before the ligament.  But, in older children and teens, the reverse occurs.

The severity of a sprain depends on just how much damage occurs to the ligaments. A grade 1 sprain is just some stretching of the ligaments, and may result in soreness and a bit of swelling.  Grade 2 is a moderate sprain with partial tearing resulting in pain, swelling, and an inability to bear weight easily.  Grade 3 injuries are complete tears, with the ankle feeling loose and unsteady, and come with a substantial amount of pain and swelling. 

How can you tell if your child has experienced a sprain?  If it hurts enough that your child or you feel the need to call a doctor, that may itself suggest a sprain, if not a fracture of the foot, and as a result your child’s doctor will want to examine the foot and possibly get x-rays or even consult with a bone or sports medicine specialist.

Treatment depends on the severity of the sprain and may last a week for a grade 1, and several weeks for grades 2 and 3. 

In all cases, the first step is to initiate what is called RICE therapy for at least the first 48 hours:

Anti-inflammatory medications like ibuprofen can also reduce the swelling.  Return to play depends upon the severity of the sprain and the approval from your child’s doctor, as well as an exercise regimen to strengthen the torn ligaments.  Often grade 2 or 3 sprains may require a splint to help immobilize the ankle until it heals, but only rarely is surgery indicated to repair the ligament.

Of course the best way to deal with a sprain is to prevent it from happening. First make sure your child warms up and stretches before playing a sport.  Remind your child to watch where they walk if they are on an uneven surface.  High top shoes may help as well to stabilize the ankle when participating in an athletic activity.      

Hopefully tips like this will not be painful ones to think about the next time your child injures his or her ankle. 

Lewis First, M.D., is chief of Pediatrics at Vermont Children's Hospital at Fletcher Allen Health Care and chair of the Department of Pediatrics at the University of Vermont College of Medicine. You can also catch "First with Kids" weekly on WOKO 98.9FM and WPTZ Channel 5, or visit the First with Kids video archives at http://www.FletcherAllen.org/firstwithkids