About Growth Plate Injuries in the Ankle
Growth plates are areas of new bone growth in children and teens. They’re made up of a rubbery, flexible material called cartilage. Most growth plates are located near the ends of long bones. Long bones are bones that are longer than they are wide. They include:
- the femur (thighbone)
- the lower legs (tibia and fibula)
- the forearm (radius and ulna)
- the bones in the hands and feet, including growth plates in the ankle
As children grow, the growth plates harden into solid bone. Once this happens, the growth plate is fully “closed” and the bones will no longer grow. Growth plates usually close near the end of puberty. For girls, this is typically at the ages of 13–15, while boys’ growth plates will close between 15–17. If the growth plate is damaged badly, it may close prematurely, which is why you should take your child to the doctor immediately if you suspect an injury has occurred.
An injury to the ankle growth plate is one of the most common growth plate injuries.
Anatomy of the Ankle Growth Plate
Growth plates in the ankle are located at the end of the tibia and fibula. They combine with the talus bones to form the ankle joint, which helps a person to walk, run, and jump. As children grow, the growth plates in the ankle enable the bones to lengthen and widen naturally. These growth plates are important in childhood development. However, because they are the last portion of bones to harden, they are particularly susceptible to fractures.
Common Injuries to the Ankle Growth Plate
A broken growth plate in the ankle is common for pediatric patients. This occurs when the growth plate is damaged—usually when the foot or lower leg twists during sports, play, or other activities. These injuries are most common when the growth plate begins to close and harden. Many times, the injury to the growth plate will result in a sprain, which causes pain and other symptoms but does not fracture the area. If a fracture occurs, your pediatrician will work to determine the best course of action, which could include bracing, a cast, or surgery.
Because children are so active, there is a high risk that they will injure their ankles during the normal course of the day. This risk is even higher for children in sports as they continuously repeat the same motions during practice and games. These repetitive injuries are extremely common in growing children, which is why stretching, rest, and other preventative measures are so important.
Symptoms of Growth Plate Injuries
The most common symptoms of a damaged growth plate in the ankle are pain and swelling at the point of injury. Other symptoms include an inability to stand or walk, bruising, and tenderness to touch. Children experiencing growth plate ankle injuries will likely find it difficult to walk unassisted or bear weight. Due to these issues, it is best to immediately help the child off their feet and limit physical activity until a doctor can be consulted.
Diagnosis
When a growth plate ankle injury first happens, it can be difficult to tell whether it is a sprain or a fracture. The first step is a physical examination. Your child’s doctor will begin by asking how the injury occurred, then they will check tenderness and swelling, range of motion, whether the ankle appears crooked, and other factors that indicate the severity of the damage. The younger the patient, the more likely they have sustained a fracture through one of the growth plates, rather than just an injury to the ligaments.
If the doctor suspects a fracture, they will likely order further testing to confirm. The most common test is an X-ray, which looks at the impacted area. While growth plates don’t show up clearly on X-rays, the test will help the doctor assess whether the growth plate is still positioned correctly in the ankle joint. If it appears to have moved (i.e., been displaced), that is one indicator that a fracture has occurred. If more information is needed, your doctor may also order a CT Scan or MRI to confirm the severity of the injury and whether the symptoms may be due to a sprain or a fracture in another part of the bone.
Treatment Options
For many patients with ankle injuries in the growth plate, rest and immobilization of the impacted area are sufficient to aid full recovery. In some cases, physical therapy may be necessary to rehabilitate the area and improve mobility. Your pediatrician will work with you to determine the best treatment plan according to your child’s injury, age, activity level, and other factors.
While painful, fractures in the growth plate of the ankle are often successfully treated in 3-6 weeks with a cast or simple walking boot. If the growth plate is displaced, the pediatrician may manually realign the bone and then prescribe a cast or walking boot. In more severe cases, the patient’s bone may stop growing. If this occurs, surgery may be necessary to remove part or all of the growth plate to prevent a limb deformity. In extremely rare cases, limb lengthening surgery may be considered.
Once treatment is completed, regular follow-up visits with your child’s doctor should continue for at least one year after the injury. Complicated fractures may require further follow-ups as the growth plate heals and eventually closes.
Recovery and Rehabilitation
Whether using a walking boot, resting, or completing physical therapy, your child must have a clearly defined treatment plan. At Rady Children’s, our Physical Therapy Department offers a range of rehabilitative services for children of all ages. The team includes licensed physical therapists, licensed physical therapy assistants, and physical therapy aides working in concert to return your child to full function.
For young athletes, our Sports Medicine Program provides comprehensive, state-of-the-art services designed to return them to the field. Our surgeons are leaders in ligament reconstruction techniques that preserve growth, and our physical therapists work to ensure patients’ fitness during the recovery process.
- Orthopedic assessments and treatment
- Sports physical therapy
- Sports Injury Prevention Program
- Nutrition counseling
Prevention
While injuries occur, there are ways to prepare your child for physical activity, especially when they are active in sports. These include:
- Warming up with efforts specific to the physical activity, including stretching before and after exercise
- Wearing well-fitting and supportive shoes
- Following conditioning exercises to train muscles and balance
- Monitoring the child’s activity levels and practice time
- Employing taping, icing, and other methods at the direction of your pediatrician or sports medicine professional
Repetitive motions are a major cause of growth plate injuries. To avoid this, make sure you are closely watching your child’s physical activity and limiting the amount of sports played during a season. When in doubt, consult your child’s pediatrician, team trainer, or other medical professional to best prevent and treat any issues they may be having.
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The growth plate in the ankle performs a pivotal function for growing children. While sprains are common, it’s important to treat every injury seriously and ensure that more serious damage has not occurred. If your child complains of an injured ankle or is having trouble walking or running, it’s always best to have them checked out by their pediatrician. Most children who suffer growth plate injuries in the ankle will have no long-term consequences, but early intervention is important for positive outcomes.