What actually happened
The usual mechanism is the foot rolling inwards, straining the ligaments on the outside of the ankle. In a growing athlete the growth plate at the end of the fibula is also a possible site of injury, which is one reason a child who cannot weight bear, or is very tender directly over the bone, should be assessed rather than assumed to have a simple sprain.
Get it checked if
Your child cannot put weight on it, there is bony tenderness over the ankle bones, there is significant deformity, the swelling is severe and immediate, or there is numbness. Also seek advice if it is not improving at all after a week.
The first week
- Protect and use it. Walk within comfort rather than resting completely, crutches only if needed.
- Compression and elevation help swelling. Ice can help comfort in the first couple of days.
- Start gentle ankle movement early: alphabet tracing, up and down, in and out, within a comfortable range.
- Begin calf and foot activation as soon as it is tolerable, seated heel raises then standing.
- Speak to a pharmacist or GP about pain relief if it is limiting sleep or walking.
Weeks two to six
Week 1 to 2
Movement and load
Full walking, heel raises both legs then one, gentle band work in all directions.
Week 2 to 3
Balance
Single leg balance, then on unstable surface, then with head turns or a ball.
Week 3 to 4
Impact
Skipping, hopping forwards and back, then side to side, low volume.
Week 4 to 5
Speed and direction
Running, then cutting, decelerating and turning at increasing intensity.
Week 5 to 6
Sport
Non-contact drills, then full training, then match minutes.
Typical progression for a straightforward sprain.
The return to sport checklist
Meeting most of these matters more than a date on the calendar. Ankles that go back early are the ones that sprain again, and repeated sprains are what leads to chronic instability years later.
- No swelling after training and no pain walking or on stairs.
- Single leg calf raises within a couple of reps of the other side.
- Single leg balance on the injured side matching the other side, eyes closed.
- Hop for distance and side hops within about 10 percent of the other leg.
- Able to sprint, decelerate and change direction at full effort without hesitation.
Preventing the next one
The evidence for balance and neuromuscular training reducing repeat ankle sprains is strong. Two or three short sessions a week, single leg balance, hopping and landing control, kept up for several months after the sprain, are worth more than any brace.
Bracing or taping for the first season back can be reasonable for an athlete who has had several sprains, alongside the strength and balance work rather than instead of it.