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Foot and ankle

Children’s ankle sprain or Avulsion Fracture

· ·

What is an ankle sprain?

A sprained ankle is an injury that occurs when you roll, twist or turn your ankle in an awkward way. This can stretch or damage the tough bands of tissue (ligaments) that help hold your ankle bones together.

Ligaments help stabilise joints, preventing excessive movement. A sprained ankle occurs when the ligaments are forced beyond their normal range of motion. Most sprained ankles involve injuries to the ligaments on the outer side of the ankle but can also sometimes involve the ligaments on the inside of your ankle too.

Treatment for a sprained ankle depends on the severity of the injury but most recover well with a little time and then simple rehab exercises once the pain has settled.

Illustration showing two types of ankle sprains: inversion sprain on the left with a sprained lateral ligament and eversion sprain on the right with a sprained medial ligament. Both images depict the position of the foot and the affected ligaments in the ankle.

What is an avulsion fracture?

Sometimes a small piece / flake of bone may be pulled off where the ligament attaches to the bone. These are minor fractures and do not need a plaster cast. Your child may be given a moonboot to wear for up to six weeks depending on their level of pain.

Avulsion fractures are treated in the same way as a sprain. These fractures may take several weeks to heal, but sometimes your child may have some pain and swelling for three to six months. Swelling and bruising at the injury/fracture site is normal.

Foot and ankle moonboot

· ·

Your child has sustained an injury to their foot or ankle that is stable and can be managed in a moonboot. They will have been fitted with the appropriately sized boot in the Emergency Department and they should be able to walk comfortably with the boot on.

To put the boot on and off place it flat on the floor, undo the Velcro straps and place the foot into the walker. Close the lining first and then secure it with the Velcro straps. Make sure it is not too tight but also that the foot is not moving around inside the boot.

You should have received advice on how long to leave the moonboot on for. The boot can be removed for bathing or showering but they may have to sit on a stool in the shower. It can also be removed at nighttime and the leg can be elevated and supported on a pillow.

At the end of the recommended time using the boot if you have any concerns and would like your child to be reviewed again, please call 0131 312 0007 or 0131 312 0008 to arrange a follow-up appointment. You can also call this number for any questions about the boot.

Sinding-Larsen-Johansson Syndrome

· ·

It is a common cause of knee pain in children and adolescents. It is caused by repeated stress of your large thigh muscle tendon where it attaches to the top of your kneecap and shin bone. This stress results in this area becoming inflamed and painful.

What are the common symptoms?

The most common symptoms of SLJ are:

  • Knee pain either during or after participation in sports
  • Swelling at the bottom of your kneecap which can be tender to touch
  • Reduced knee strength
  • Tightness of your leg muscles.

These symptoms usually appear gradually and often after you have had a growth spurt.

These symptoms can appear in one or both of your knees.

Physiotherapy for lower limb fracture

· ·

What to expect after removing the cast

In order to help your fracture heal, the decision may be made to immobilise your leg or foot by placing it into a cast for a set period of time. This is typically around 4-6 weeks.

This will be decided by your orthopaedic doctor. After your cast is removed, you will probably have dry flaky skin, altered sensation, joint stiffness, muscle weakness and some swelling.

This leaflet will provide advice and exercises to help with these effects.

Skin Care

After your cast is removed it is helpful to massage non-perfumed moisturiser over your leg.

This will help hydrate the dry skin while also providing a positive touch to an area that has not been touched or moved for a period of time.

This will help with dry skin and sensory concerns

Exercises

The following exercises will help reduce swelling and stiffness and increase your joint movement.

Carry out these exercises regularly and gradually work through them. The exercises get harder as you work through the leaflet so it may be a few weeks before you can manage them all.

Exercises may feel difficult at first but should not be painful. If an exercise is painful, you should stop and try again later.

© Physiotools

Exercise 1

Circle and paddle your ankles back and forth 10 times each as regularly as you can throughout the day.

This can be done while you are lying or sitting.

© Sarah Crombie

Exercise 2

  • Lie on your back and draw your feet under your knees.
  • Keep your knees hip-width apart.
  • Lift your hips up high.
  • Hold for 5 seconds at the top then slowly lower down.
  • Repeat 10 times
© Physiotools

Exercise 3

  • While sitting in a chair point your toes up and kick your foot up to straighten your knee.
  • Hold for 3 seconds at the top.
  • Slowly lower back down.
  • Repeat 10 times.

 

© Physiotools

Exercise 4

  • Start on all fours.
  • Straighten your knees while trying to keep your heels on the ground.
  • Hold for 20 seconds.
  • Slowly lower down onto your knees.
  • Repeat 3 times.
© Physiotools

Exercise 5

  • Stand with your feet wider than your hips and with your toes pointing out slightly.
  • Bend your knees and push your hips back into a squat.
  • Keep your chest up.
  • Push back up into standing.
  • Repeat 10 times
© Physiotools

Exercise 6

  • Balance on one leg.
  • Aim to reach 30 seconds without wobbling.
  • If too tricky at the start, stand by a table for support.
  • If too easy, try throwing and catching a ball or passing it under your leg.

Activity Ideas

Your doctor will give you advice on returning to activity and sports. Here is a list of activities you can try to encourage to regain full function:

  • Short walks
  • Swimming
  • Cycling
  • Animal walks
  • Gardening
  • Squashing things with your foot

When to seek further help?

Your child may limp a little for many weeks after their cast is removed, especially in younger children and after increased activity.

If your child reports the following complaints after 3 – 4 weeks of following the advice in this leaflet please call the physiotherapy team to discuss further assessment:

  • Ongoing pain which stops your child from taking part in normal activities
  • Difficulty returning to normal function
  • Ongoing stiffness.

Call our self-referral number on 0131 312 1079 Monday-Friday between 08:30-16:30.

Normal lower limb variants in childhood

· ·

Flat Feet – What are they?

Most adult flat feet have an arch along the inside edge of the foot, some higher than others. A foot is described as flat when this arch is absent or reduced in standing. All children have very flat feet when they first start walking.

As they grow and walk, the soft tissues along the bottom of their feet tighten and get stronger which gradually shapes the arches of the feet.

Children with flexible flat feet often do not begin to develop an arch until the age of 5 years or older, and the foot arch is not fully developed until around 10 years of age.

Some children never develop an arch and are never symptomatic.

When to seek help

If your child appears to be in pain or you feel their function is being affected.

Intoeing and Outtoeing – What is it?

a black and white image of a foot print

A child is said to have an in-toeing gait when they walk with their feet turned inwards.

A child is said to have an out-toeing gait when their feet turn outwards when they walk.

Both patterns in most cases are completely normal as we all have different walking patterns.

For more information please refer to the APCP Intoeing gait leaflet.

Knock knees/Bow legs – What are they?

The diagram illustrates the progression of genu varum (bow legs) and genu valgum (knock knees) based on a child’s age: At birth, newborns typically exhibit moderate genu varum (bow legs). By 6 months, the bowing decreases and becomes minimal. By the age of 1 year and 7 months, the legs usually straighten, showing no bowing. At the bottom of the diagram, it shows the progression of genu valgum (knock knees) in three stages: At around 2 years and 6 months, children develop physiological genu valgum (knock knees), often accompanied by protective toeing-in. Between the ages of 4 to 6 years, the legs straighten naturally, with a normal toeing-out.

As all children develop, their legs change shape and position. All infants have some degree of bow legs which usually resolves by the age of 2.

By the age of 4, they begin to develop knock knees and this usually resolves to straight legs by the age of 8.

A slight degree of bowing or knocking is normal.

Bow Legs (or genu varum) – When a child stands with their feet together and there is a gap between their knees. This is particularly noticeable when a child starts walking but resolves spontaneously with normal child development.

Knock Knees (or genu valgum) – When a child stands with their knees together and there is a gap between their feet. Knock knees usually resolve spontaneously although a mild degree of genu valgum is normal and sometimes persists into adulthood.

Treatment Splints, insoles and exercises do not have any effect on knock knees or bow legs. It will resolve with normal development.

When to seek help

If your child has one leg that is significantly worse than the other, severe or worsening deformity or a history of trauma or infection.

Contact NHS Lothian