What is the protocol for managing pediatric ankle sprains?

From the Guidelines

The protocol for pediatric ankle sprains follows the RICE approach: Rest, Ice, Compression, and Elevation, with a focus on functional treatment and early mobilization, as recommended by the most recent evidence-based clinical guideline 1. Children should limit weight-bearing on the injured ankle for 24-48 hours, applying ice packs for 15-20 minutes every 2-3 hours during waking hours for the first 48-72 hours. A compression bandage or elastic wrap should be applied snugly but not tight enough to impair circulation, and the ankle should be elevated above heart level when possible. For pain management, acetaminophen (10-15 mg/kg every 4-6 hours, not exceeding 5 doses in 24 hours) or ibuprofen (10 mg/kg every 6-8 hours with food, not exceeding 40 mg/kg daily) can be used, as suggested by previous studies 1. Most pediatric ankle sprains heal within 2-6 weeks depending on severity. Gradual return to activities should begin once pain-free walking is possible, typically starting with range-of-motion exercises, followed by strengthening exercises like ankle circles, alphabet tracing with the foot, and towel scrunches. Physical therapy may be beneficial for moderate to severe sprains, and the use of functional support, such as an ankle brace, is preferred over immobilization, as it allows for early mobilization and promotes faster recovery 1. Children should avoid returning to sports until they can hop on the injured foot without pain and have regained full strength and range of motion. This protocol works by reducing inflammation and pain while promoting proper healing of the ligaments, preventing chronic ankle instability that could lead to recurrent injuries, and is supported by the latest research on the diagnosis, treatment, and prevention of ankle sprains 1.

Some key points to consider in the management of pediatric ankle sprains include:

• The importance of early mobilization and functional treatment, as emphasized by the most recent clinical guideline 1
• The use of functional support, such as an ankle brace, to promote faster recovery and prevent chronic ankle instability 1
• The need for gradual return to activities, starting with range-of-motion exercises and progressing to strengthening exercises, to ensure proper healing and prevent recurrent injuries
• The importance of pain management, using acetaminophen or ibuprofen as needed, to promote comfort and facilitate recovery 1
• The role of physical therapy in the management of moderate to severe sprains, to promote faster recovery and prevent chronic ankle instability.

From the Research

Protocol for Managing Pediatric Ankle Sprains

The management of pediatric ankle sprains involves several key components, including:

• Initial treatment with rest, ice, compression, and elevation (RICE) or protection, rest, ice, compression, and elevation (PRICE) 2, 3, 4, 5, 6
• Early mobilization, which may include the use of a stretch band ankle traction technique 3
• Proprioception exercises to help regain normal function and prevent future injuries 2
• A home exercise stretching program to remodel scar tissue and improve ankle mobility 2

Treatment Options

Treatment options for pediatric ankle sprains may vary depending on the severity of the injury, but may include:

• Conservative management with RICE or PRICE 2, 3, 4, 5, 6
• Immobilization, which may be necessary for more severe injuries or fractures 2
• Physical therapy, including exercises to improve strength, flexibility, and proprioception 3, 5
• Shockwave therapy, which may be used in combination with a home exercise program to remodel scar tissue 2

Follow-up Care

Follow-up care is an important part of managing pediatric ankle sprains, and may include:

• Scheduled follow-up appointments with a healthcare provider 4
• Referral to a specialist, such as an orthopedic clinic or physical therapist 4
• Education on proper treatment, rehabilitation, and follow-up care to minimize the risk of long-term sequelae 4