Pediatric Ankle and Foot Injuries: Identification and Management in the Emergency Department (Trauma CME) -
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Publication Date: March 2023 (Volume 20, Number 3)

CME Credits: 4 AMA PRA Category 1 Credits™, 4 ACEP Category I Credits, 4 AAP Prescribed Credits, 4 AOA Category 2-A or 2-B Credits. CME expires 03/01/2026.

Specialty CME Credits: Included as part of the 4 credits, this CME activity is eligible for 3 Trauma credits, subject to your state and institutional approval.

Authors

Elizabeth Zorovich, MD

Pediatric Emergency Medicine Fellow, University of Florida College of Medicine – Jacksonville, Jacksonville, FL

Vlad Panaitescu, DO

Assistant Professor of Emergency Medicine, University of Florida College of Medicine – Jacksonville, Jacksonville, FL

John Kiel, DO, MPH, FACEP, CAQ-SM

Assistant Professor of Emergency Medicine, Assistant Professor of Orthopaedics & Sports Medicine, University of Florida College of Medicine – Jacksonville, Jacksonville, FL

Peer Reviewers

Joyce Li, MD, MPH

Assistant Professor of Pediatrics and Emergency Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA

Paula J. Whiteman, MD, FACEP, FAAP

Associate Professor of Emergency Medicine, Cedars-Sinai Medical Center, Los Angeles, CA

Abstract

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. This issue reviews the presentation, systematic evaluation, and management of common pediatric orthopedic injuries of the ankle and foot. Recommendations are given for the disposition of pediatric patients with ankle and foot injuries, with a focus on which patients need immediate orthopedic evaluation and which patients can be discharged home with appropriate follow-up.

Case Presentations

CASE 1

A 2-year-old girl is brought into the ED by her parents for evaluation of right leg pain...

The mother states that for the past 4 hours the girl will not walk and has been crawling around the house. Previously, the patient was walking independently. There was no witnessed fall or trauma.
On examination, the patient repeatedly refuses to bear weight on her right leg. There is no obvious injury or deformity of the right leg. The girl cries when the tibia is palpated.
What is on your differential? How should you manage this type of injury? Does this injury need immediate orthopedic evaluation?

CASE 2

A 17-year-old boy presents to the ED with right foot pain 4 days after falling while snowboarding…

The patient was previously seen in another ED immediately after the injury and was diagnosed with an ankle sprain. The patient states that his foot now looks more swollen and bruised since the incident. The patient also states he cannot bear weight on his right foot.
On examination, there is significant ecchymosis and swelling of the right foot. There is also point tenderness on the anterior aspect of the ankle.
Should you re-image the injury? What other conditions are of concern?

CASE 3

A 14-year-old girl presents to the ED for left foot pain...

The patient is a ballet dancer. She was at dance class today when she said she rolled over her foot after landing a jump. The patient locates the pain to the left fifth toe.
On examination, you note point tenderness of the fifth metatarsal.
Based on this mechanism of injury and presentation, what injuries are you concerned for?

Accreditation:

EB Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.