Ankle Injuries in Children and Adolescents

Abstract

Every general pediatric practice has its share of minor orthopedic trauma, comprising approximately 5% of the average practice. In practices slanted toward the care of adolescents or athletes the percentage is higher. The vast majority of these injuries occur to the ankle and knee, however; this article will discuss ankle injuries exclusively. Whether you are dealing with athletes or with active children and adolescents, the proper diagnosis, treatment, and rehabilitation of common ankle injuries is an important aspect of general pediatric practice. Failure to treat a specific injury properly may not only prolong the discomfort and disability produced by the injury but may produce the end result of a chronically unstable ankle and possible degenerative joint disease. ANATOMY AND BIOMECHANICS Proper diagnosis of ankle injuries requires a knowledge of the anatomy of the bones and ligaments that make up the ankle joint (Fig 1). The distal ends of the fibula and tibia are held in close approximation by ligamentous structures to produce an ankle mortise lined with articular cartilage. This surface articulates with the cartilaginous surface of the dome of the talus. The anterior and posterior tibiofibular ligaments (syndesmosis) are responsible for holding the distal tibia and fibula together. The joint proper is stabilized medialy and laterally by the distal processus of these bones as well as attached ligaments.