Pediatric Ankle and Foot Injuries: Identification and Management in the Emergency Department (Trauma CME)

Points & Pearls Excerpt

• 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.³ 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 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.)