Last reviewed: September 29, 2026

Most twisted ankles in children are sprains. A true growth plate fracture is less common than many parents are told.

The growth plate is a layer of cartilage near the end of a growing bone. It is weaker than the ligaments around it, so doctors have long worried about it. Children with pain on the outer ankle and a normal X-ray have often been treated as if they had a growth plate fracture.

MRI studies have changed that view. In a study of 135 children ages 5 to 12 with pain on the outer ankle and a normal X-ray, MRI found a growth plate fracture in only 4. Most had a sprain. Some also had a small chip of bone pulled off by a ligament that the X-ray did not show. Children with and without a fracture recovered equally well in a removable brace.

Not every twisted ankle needs an X-ray. Doctors use bedside checklists, such as the Ottawa Ankle Rules, based on where the ankle is tender and whether the child can walk. In a review of 12 studies of more than 3,000 children older than 5, the Ottawa rules picked up 98.5% of fractures and cut X-rays by about a quarter. A similar rule, tested in 2,151 children, missed no important fractures.

Low-risk injuries are usually treated simply. In a trial of 104 children, those given a removable ankle brace had better function at 4 weeks than those in a walking cast, and more were back to their usual activities. The evidence comes from a few small trials.

Some growth plate fractures are more serious. These usually involve the shinbone at the ankle, not the thin outer bone. They may need a cast, or surgery if the pieces have shifted. In hospital studies of these fractures, between 13% and 27% of children later had the growth plate close too early. Some then needed surgery for a short or crooked leg. The risk was higher in younger children and when a gap remained between the pieces.

Growth plate fractures happen about twice as often in boys, because girls finish growing earlier.

In general:

  • If your child cannot stand or walk, or the ankle looks deformed, have it checked promptly.
  • Ask whether an X-ray is needed. For many twisted ankles it is not.
  • After a growth plate fracture of the shinbone, ask about follow-up visits to check growth.
  • A return to sport is usually reasonable once pain and tenderness are gone.

Drafted with AI assistance from published sources, reviewed and edited by Babak Sheikh, MD.

Sources:

This is general information about what published research shows. It is not medical advice and it is not about your situation. Reading it does not create a doctor-patient relationship with me. I am a retired orthopedic surgeon and I do not see patients. Talk with your own doctor before changing anything about your care. If something feels suddenly or seriously wrong, get medical care promptly rather than waiting.

This page is provided as is. I make no guarantee that it is accurate, complete or current, and medical evidence changes. Use of it is at your own risk.

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