Non-Operative — Lateral Ankle Sprain — Non-Operative (Pediatric)

Massachusetts General Hospital · MGH Brigham Pediatric Sports Medicine

Weight-Bearing

WBAT with brace; Grade 3: immobilization 10 days

Key Restrictions

Brace during WB activities; Grade 3 sprain: immobilization recommended 10 days; Ottawa ankle rule to rule out fracture; screen for physeal fractures (epiphyseal plate injuries common in active pediatric population); discharge criteria: >=90% heel rise, >=90% SEBT, >=90% hop testing

Timeline & Phases

Phase I (0-2 wks): normalize gait, ankle ROM/mobility, tandem/SL balance on firm surface if non-painful, Grades I-II joint mobs; Phase II (2-4 wks): progressive strengthening (resisted ankle 4-way, heel raises, step-ups), Grades I-IV mobs, balance on unstable surfaces; Phase III (4-6 wks): closed chain strengthening, return-to-run program, double-leg plyometrics/agility ladder; Phase IV (6-8 wks): SL hopping, multi-plane sport-specific plyometrics and agility

Notes

Revised 5/2024; pediatric-specific protocol emphasizing physeal fracture screening and epiphyseal plate awareness; includes BAPS board, Star Excursion Balance Test; grade-specific management; discharge >=90% heel rise/SEBT/hop testing. [Archived copy — original Massachusetts General Hospital URL retired in the Mass General Brigham site migration; Wayback snapshot 2025-02-16.]

Surgeon / Author

MGH Brigham Pediatric Sports Medicine

Published

2024-05