Treatment for Subtle Physeal Injury of the Ankle
Functional treatment is the preferred approach for subtle physeal injuries of the ankle, consisting of 3-5 days of rest, ice, compression, and elevation followed by early weight bearing and active exercise. 1
Initial Management
- Apply the PRICE protocol (Protection, Rest, Ice, Compression, and Elevation) for the first 4-5 days to control pain and swelling 1
- NSAIDs may be used to reduce pain and swelling in the acute phase, which can improve healing and speed recovery 1, 2
- A short period (10-14 days) of immobilization in a below-knee cast or brace may help diminish pain and swelling 1
- For protection during the initial phase, a semirigid brace is the most cost-effective option compared to taping 1
Rehabilitation Protocol
Early Phase (Days 1-5)
- Control acute inflammation with RICE therapy 1, 3
- Begin range-of-motion exercises as soon as tolerated to maintain joint mobility 2, 4
- Initiate isometric strengthening exercises when pain allows 4
Intermediate Phase (Days 6-14)
- Progress to isotonic strength training exercises 4
- Introduce proprioception training exercises to improve balance and coordination 2, 4
- Continue with functional support (brace or tape) to provide stability 1
Advanced Phase (2+ weeks)
- Implement sport-specific or activity-specific exercises to prepare for return to normal activities 2, 4
- Supervised exercises focusing on proprioception, strength, coordination, and function are strongly recommended 2
- Gradually reduce dependence on supportive devices as strength and stability improve 1
Important Considerations
- Physeal injuries account for approximately 15-18% of all pediatric fractures and require careful management to prevent growth disturbances 5
- Inadequate treatment of physeal injuries can lead to complications such as decreased range of motion, pain, joint instability, and potential growth arrest 1, 5
- Anatomical reduction is crucial for physeal fractures to prevent malunion, incongruous articular surfaces, and premature cessation of growth plate activity 6, 5
- Regular follow-up is essential to monitor healing and detect any early signs of complications such as bony bar formation 5, 7
Prevention of Recurrence
- Functional support (bracing) is effective in preventing recurrent ankle injuries 1
- Neuromuscular training has shown significant preventive effects for recurrent ankle sprains 1
- Ankle disk or proprioceptive neuromuscular facilitation exercise regimens may be helpful in preventing future injuries 1
Return to Activities
- Functional treatment allows patients to return to sports approximately 4.6 days sooner than immobilization 2
- Patients undergoing functional treatment returned to work 7.1 days sooner than those treated with immobilization 2
- A structured return-to-activity schedule should be implemented to minimize absence from school, sports, or other activities 2