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Limited dorsiflexion predisposes to injuries of the ankle in children

Division of Orthopaedic Surgery, Children’s Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, Ontario, Canada K1H 8L1.

M. B. Quesnel, SCPT, Physiotherapist

Division of Orthopaedic Surgery, The Ottawa Hospital - General Campus, 401 Smyth Road, Ottawa, Ontario, Canada K1H 8L1.

A. W. Howard, FRCS C, Assistant Professor

Division of Orthopaedic Surgery, Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, Canada M5G 1XB.

Correspondence should be sent to Dr A. W. Howard.

Injuries to the ankle are common in children. We investigated whether decreased dorsiflexion predisposes to such fractures and sprains. Passive dorsiflexion in children with ankle injuries was compared with that in a control group of patients with a normal ankle. The uninjured side was examined to determine flexibility in those patients with ankle injuries. In 82, the mean dorsiflexion was 5.7° with the knee extended and 11.2° with the knee flexed. In 85 controls, the mean dorsiflexion was 12.8° with the knee extended and 21.5° with the knee flexed (p < 0.001, Student’s t-test). There was a strong association between decreased ankle dorsiflexion and injury in children. A flexible triceps surae appeared to absorb energy and protect the bone and ligaments, while stiffness predisposed to injury. We suggest that children with tight calf muscles should undergo a regimen of stretching exercises to improve their flexibility.