ankle pain in child

My daughter hurt her ankle a few years ago. We took her to Dr and said it was a sprain. She has recently been having problems with it hurting on and off. It will only hurt for a day and by the next day it feels much better. Other than having her stay off it, put it up with ice, and give her Tylenol, what can I do? Should she go back to the Dr or is this something she will just have to deal with?

RESPONSE

Hi,

The decision to go back to the doctor depends on how much pain your daughter is in and how much it affects her ability to carry on her daily activities.

If for example, she is very athletic then this is obviously a problem and will need further treatment; if she is sedentary and the pain is bearable, then she may be able to live with it, with the understanding that it may worsen over time.

You do not mention how old your daughter is but the younger she is the greater chance there may be more residual damage then lets say if she is in her late teens.

I would assume when she injured herself, the doctor took an x-ray and observed there was no fracture so the diagnosis then became a sprained ankle. This is common practice, but the problem with this is that an x-ray does not tell us to what degree the soft tissue (everything but bone) was damaged.

In other words, she may have sprained the ligaments that attach the foot to the ankle, or she may have actually torn one or more of the ligaments, in which case there can be residual damage which may be the cause of her ongoing episodic pain.

The problem that occurs in a ligament tear or even a very severe sprain is that the ligaments which hold bone to bone, develop scar tissue. As you can imagine, scar tissue is not like normal tissue and any excess scarring may then cause pain in the affected area. It does not have to occur on a daily basis but rather may occur on an infrequent schedule.

Even people who repeatedly sprain an ankle without tearing the ligaments will eventually end up with scar tissue that in many cases can be an ongoing issue.

So, again, if the pain in your daughter's ankle is severe enough and debilitating enough, then a thorough examination of the ankle needs to be done. This would include a new set of x-rays as well as an MRI which will rule out any soft tissue changes to the ankle as well as perhaps showing any remnants of an old fracture which may not have shown up on the initial x-rays.

I think it is worth pointing out that sometimes ankles will hurt without trauma, mainly due to the way the foot lines up relative to the ankle. This is mainly due to a mal-alignment problem and can cause pain either on the inside or outside of the ankle. I mention this because sometimes people get caught up thinking their ankle pain is the result of trauma and they have "blinders on" as to other possible causes.

If you decide not to go to the doctor, even though I suggest that is what you do, the only other thing you can try is an ankle support of some sort. They can be purchased in drug stores or on the internet. An ankle support will stabilize the foot to the ankle and thus lessen the strain on the ligaments which should reduce pain. The problem with just doing that and not seeing a doctor is that your daughter's ankle pain may then become a chronic condition meaning she will have to deal with it for the rest of her life.

Marc Mitnick DPM
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