Pediatric ankle and foot injuries are common complaints in the emergency department, and proper identification and management of these injuries is critical for uninterrupted limb development.
Our recent issue Pediatric Ankle and Foot Injuries: Identification and Management in the Emergency Department reviews the presentation, systematic evaluation, and management of common pediatric orthopedic injuries of the ankle and foot.
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Here are a few key points:
- In preadolescent children, growth plates and bones are weaker than ligaments. Ankle trauma is more likely to cause fractures of the physis, adjacent epiphysis, and/or metaphysis than ligamentous injuries. As the child continues to develop and growth plates fuse, there is a higher incidence of ligamentous injuries.
- In the differential diagnosis of pediatric ankle and foot injuries, consider the patient’s age, level of activity, and the location of pain. See Table 1 in the issue for classic pediatric ankle and foot injuries, by location.
- The approach to the ankle and foot examination should be standardized and consistent across patients. The IP-PASS mnemonic can be used to remember the steps in a thorough ankle and foot examination.
- Decision-making tools such as the Ottawa ankle rule can be used to decide which injuries to image. (See Figure 8 in the issue).