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.
How would you manage these patients? Subscribe for evidence-based best practices and to discover the outcomes.
Subscribe to access the complete flowchart to guide your clinical decision making.
Subscribe for full access to all Tables.
Buy this issue and
Following are the most informative references cited in this paper, as determined by the authors.
1. * Su AW, Larson AN. Pediatric ankle fractures: concepts and treatment principles. Foot Ankle Clin. 2015;20(4):705-719. (Review) DOI: 10.1016/j.fcl.2015.07.004
3. * Fleisher GR, Ludwig S, Anderson A. Injury-Ankle. In Fleisher GR, Ludwig S, eds. Textbook of Pediatric Emergency Medicine. 6th ed. Lippincott Williams and Wilkins; 2010:337-344. (Textbook chapter) ISBN: 978-1605471594
8. * Fleisher GR, Ludwig S, Bachman D, et al. Musculoskeletal trauma. In Fleisher GR, Ludwig S, ed. Textbook of Pediatric Emergency Medicine. 6th ed. Lippincott Williams and Wilkins; 2010:1335-1375. (Textbook chapter) ISBN: 978-1605471594
10. * Cepela DJ, Tartaglione JP, Dooley TP, Patel PN. Classifications in brief: Salter-Harris classification of pediatric physeal fractures. Clin Orthop. 2016;474(11):2531-2537. (Review) DOI: 10.1007/s11999-016-4891-3
11. * Salter RB, Harris WR. Injuries involving the epiphyseal plate. J Bone Joint Surg Am. 1963;45(3):587-622. (Review)
13. * Solove M, Turcotte Benedict F. Ankle injuries in the pediatric emergency department. Pediatr Emerg Care. 2020;36(5):248-254. (Review) DOI: 10.1097/PEC.0000000000002097
18. * Smidt KP, Massey P. 5th metatarsal fracture. In: StatPearls. StatPearls Publishing; 2022. Accessed February 1, 2023. (Review)
19. * Bickley L. Bates’ Guide to Physical Examination and History Taking. 10th ed. Lippincott Williams and Wilkins; 2009. (Textbook) ISBN: 978-1605478036
26. * Boutis K, Willan AR, Babyn P, et al. A randomized, controlled trial of a removable brace versus casting in children with low-risk ankle fractures. Pediatrics. 2007;119(6):e1256-e1263. (Randomized controlled trial) DOI: 10.1542/peds.2006-2958
27. Shamrock AG, Varacallo M. Triplane ankle fracture. In: StatPearls. StatPearls Publishing; 2022. Accessed February 1, 2023. (Review)
29. * Boutin A, Misir A, Boutis K. Management of toddler’s fracture: a systematic review with meta-analysis. Pediatr Emerg Care. 2022;38(2):49. (Systematic review; 4 studies, 355 participants) DOI: 10.1097/PEC.0000000000002488
32. * Herrera-Soto JA, Scherb M, Duffy MF, et al. Fractures of the fifth metatarsal in children and adolescents. J Pediatr Orthop. 2007;27(4):427-431. (Retrospective study; 103 patients) DOI: 10.1097/01.bpb.0000271323.56610.da
Subscribe to get the full list of 35 references and see how the authors distilled all of the evidence into a concise, clinically relevant, practical resource.
Keywords: ankle injury, foot injury, orthopedic injury, ankle joint, ligament, ankle sprain, low ankle sprain, medial ankle sprain, high ankle sprain, distal fibula fracture, distal tibia fracture, Satler-Harris fracture, Tillaux fracture, triplane fracture, toddler fracture, talus, lateral talus fracture, snowboarder’s fracture, tarsal fracture, metatarsal fracture, Jones fracture, pseudo-Jones fracture, Lisfranc injury, nontraumatic foot pain, nontraumatic ankle pain, IP-PASS, Thompson test, squeeze test, single-leg heel raise, PRICE-FM, Sever disease, Iselin disease, Frieberg disease
Elizabeth Zorovich, MD; Vlad Panaitescu, DO; John Kiel, DO, MPH, FACEP, CAQ-SM
Joyce Li, MD, MPH; Paula J. Whiteman, MD, FACEP, FAAP
March 1, 2023
March 1, 2026   CME Information
4 AMA PRA Category 1 Credits™, 4 ACEP Category I Credits, 4 AAP Prescribed Credits, 4 AOA Category 2-A or 2-B Credits. Specialty CME Credits: Included as part of the 4 credits, this CME activity is eligible for 4 Trauma credits, subject to your state and institutional approval.