Tilt-A-World

This week's guest columnist is Rachel Jacobs, MD, a family practice resident at Ochsner University Hospital & Clinics.

Excited and full of candy, my brother and I skipped out of the movie theater, reliving our favorite parts. That “reliving” caused me to skip off the curb and twist my ankle. “Ouch!” Mom looked it over and sighed—another sprain! I’d had so many ankle injuries that crutches lived in the corner of my room, waiting for more business. Either I was a klutz or the rest of the world was slightly tilted, causing me to keel over so often.

Ankle injuries are a common emergency department visit. Parents wonder, with the pain and swelling, whether it's broken and needs casting. Also, kids often need school excuses for PE and sports signed by a doctor. However, most ankle injuries are sprains, which can be treated at home.

If the pain isn't so bad and your child can put some weight on it, it's probably not broken. Follow the home treatment acronym R.I.C.E.: Rest, Ice, Compression and Elevation. Rest means taking a few days to take it easy, avoiding painful activities. Ice can be your favorite bag of frozen peas (this happened so often to me that I had a “favorite” bag!) laid over your ankle to decrease pain and swelling. Compression is usually an ACE bandage wrap. Elevate the leg when sitting still to ease throbbing and swelling, too.

Luckily for me and this particular injury, I was able to avoid a visit to the ER because my mom and I had so much experience with RICE therapy. We dusted off the crutches, and off I went to school. At recess, I put my ankle up on a bench and acted as judge as my friends raced each other on my crutches. Don't fall!

There are times when ankles are obviously broken, like when they are bent like a golf club. This is when we don't need x-rays to tell family there's going to be surgery. It's also a safe bet with high-energy impacts, like being thrown from ATVs or double-tackled in football games.

However, there are a slew of injuries in between the crooked ankle and the child who steps wrong but walks away without limping. When to go to the emergency department? If children are unable to walk, that's a good time to visit us. If it's broken, they'll need a cast. But even if it's only sprained and expected to be better in a few days, those kids will need a splint to avoid pain and promote healing. Children who can't walk will need crutches to get around.

Other bad signs include numbness and tingling in the foot below the injured ankle or lots of swelling. Finally, if you are in severe pain and moving the injured part is difficult, get to the ER and call EMS to get there. Paramedics carry pain medication and splints to immobilize ankles, and they can carry the whole child too! It can take several people to get kids with bad injuries off the ground and into a truck without hurting them too much.

Children are supposed to be active: running, jumping, climbing and having fun. They will hurt their ankles, some more than others, like me. But, as mentioned above, I blame it on the whole world being slightly tilted rather than innate clumsiness on my part. That's my story, and I'm sticking with it!