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Old 29.08.2011, 07:47
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Broken ankle #3? - now what?!

Well, I can't believe it, but it has happened again. UGH.

Last year my daughter, age 10 at the time, broke her ankle while getting jostled on the bus stairs. They thought initially that it wasn't broken but it turned out to be a tiny fracture plus perhaps a sprain and long story short, two casts and lots of back and forth to doctors, she healed but never absolutely entirely, because occasionally she still felt some discomfort.

She is very active nonetheless, and the doctors encouraged her to continue with her sports unless she felt again that something was wrong.

My doctor in the U.S. said she really never received the best treatment here in CH, even though I sent her to specialists at the hospital in Lausanne. He felt that all along she needed to see a foot specialist, and the pediatric bone specialist wasn't the best referral.

Now one week back in CH, we went for a short hike, one minor misstep and my daughter now has a swollen ankle and we are going back to the hospital for an evaluation. She says it feels just like the time she broke it last year.

(BTW - Why #3? My son, age 8, broke his ankle similarly while bouncing gently on a trampoline. But his healed up after a few weeks and he has no troubles with it)

Can anyone recommend a good pediatric foot doctor in Lausanne? I think physical therapy could ultimately be a good idea to strengthen her ankles, but in the meantime, I want to ask someone if there is something inherently not quite right about her ankles that keeps causing her such trouble!

Thank you ever so much to anyone that can help.
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Old 29.08.2011, 09:32
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Re: Broken ankle #3? - now what?!

Sorry for your daughter's misfortune; I sincerely hope that you find that she only strained or sprained her ankle this time.

My son had also had the misfortune to break the same bone in his foot three times in slightly over two years, all while playing basketball. Our orthopedist in the US explained that sometimes kids who are going through the rapid growth of adolescence have a lag in the adequate calcification, or hardening/strengthening of new bone, that has been laid. This can make them prone to fractures.

Does your daughter take in adequate calcium? Perhaps if she does not like milk products, you could find a supplement that she could take? Also, you might talk to the physician about whether some sort of ankle brace would be appropriate in her case.

Good luck, and I hope you receive good news from the hospital!
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Old 29.08.2011, 10:39
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Re: Broken ankle #3? - now what?!

Thanks, I hope so too! So nice to hear from someone who has been through something similar. Part of me feels as though it is somehow my fault for not better protecting her or finding better medical care, that she is hurt again...But it is rather impossible to keep an active child still for long, as I'm quite sure you know.

Can I ask, how long ago did your son break his ankle? I am wondering if he has since grown, the calcifcation process is further along and now no more ankle troubles?

I think she takes in quite enough milk products. She moves quickly and trips constantly, bumping into things and crying out all the time! She is a gifted ballet dancer, but you'd never know it if you saw her off the stage. She has more than perfect vision, but otherwise I'd suspect that she needs glasses, too, poor dear!

I'm taking her to the hospital this afternoon, so we'll see what they find. At least, I know my way...
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Old 29.08.2011, 10:59
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Re: Broken ankle #3? - now what?!

Has she done any physiotherapy after having getting the cast(s) off?

If not, she should have. You may have to "insist", but up to ten sessions of specialized physio are required to "rebuild" the proprioceptive system.

You can lose it after you have had the foot in a cast for as little as 2-3 weeks. As a "quick and dirty" explication, the proprioceptive system is really your automatic balance system.

The physio will concentrate on balance exercises (on uneven or moving surfaces) so she will have the reflex to right herself when she goes partially over on the ankle. This will protect it and hopefully avoid strains (which further weaken the ligaments and muscles).

I have had this done at VidyMed in Lausanne/Vidy but I am sure there are other physio centrers that can do it once they know you want her to have Proprioceptive training for the ankle. If prescribed by the doctor, these sessions are covered by insurance.
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Last edited by Verbier; 29.08.2011 at 11:01. Reason: typo
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Old 29.08.2011, 11:00
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Re: Broken ankle #3? - now what?!

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Thanks, I hope so too! So nice to hear from someone who has been through something similar. Part of me feels as though it is somehow my fault for not better protecting her or finding better medical care, that she is hurt again...But it is rather impossible to keep an active child still for long, as I'm quite sure you know.

Can I ask, how long ago did your son break his ankle? I am wondering if he has since grown, the calcifcation process is further along and now no more ankle troubles?

I think she takes in quite enough milk products. She moves quickly and trips constantly, bumping into things and crying out all the time! She is a gifted ballet dancer, but you'd never know it if you saw her off the stage. She has more than perfect vision, but otherwise I'd suspect that she needs glasses, too, poor dear!

I'm taking her to the hospital this afternoon, so we'll see what they find. At least, I know my way...
My son actually broke his fifth metatarsal (bone connecting ankle to little toe), twice on one foot and once on the other. Always due to rolling his foot outward while coming down from jumping while playing basketball. He was 13 the first two times and 15 the last time. The first two times were right in the middle of his biggest growth spurt (I believe the last time was just a fluke). A cast was put on the first time, however a splint and walking boot were deemed sufficient the last two. He is almost 17 now, but I still worry when he plays basketball!

It is good that your daughter is active, and ballet certainly contributes to balance (I have a daughter who dances as well)! Hopefully she is going through a sort of "clumsy" stage, where she has not quite gotten used to how long her own limbs are (quite common for adolescents). Is she on pointe yet in ballet? In the US, my daughter's dance instructor was very particular about evaluating the apparent ankle strength of her pupils prior to letting them join pointe class. Be careful with that, given her history!
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Old 29.08.2011, 14:49
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Re: Broken ankle #3? - now what?!

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Has she done any physiotherapy after having getting the cast(s) off?

If not, she should have. You may have to "insist", but up to ten sessions of specialized physio are required to "rebuild" the proprioceptive system.

You can lose it after you have had the foot in a cast for as little as 2-3 weeks. As a "quick and dirty" explication, the proprioceptive system is really your automatic balance system.

The physio will concentrate on balance exercises (on uneven or moving surfaces) so she will have the reflex to right herself when she goes partially over on the ankle. This will protect it and hopefully avoid strains (which further weaken the ligaments and muscles).

I have had this done at VidyMed in Lausanne/Vidy but I am sure there are other physio centrers that can do it once they know you want her to have Proprioceptive training for the ankle. If prescribed by the doctor, these sessions are covered by insurance.
Thanks Verbier! Just at the time my daughter was referred for physical therapy, it was time to go see the family in the States. I tried to hook her up with someone there, but he was on vacation.

You have just explained to me better than anyone why I should take her to these sessions. Physical therapy was recommended to me by some, but others argued that she is already getting plenty of strength training in her regular ballet exercises. Your explanation makes the need for physical therapy more clear. I'll see to it right away.
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Old 29.08.2011, 14:54
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Re: Broken ankle #3? - now what?!

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My son actually broke his fifth metatarsal (bone connecting ankle to little toe), twice on one foot and once on the other. Always due to rolling his foot outward while coming down from jumping while playing basketball. He was 13 the first two times and 15 the last time. The first two times were right in the middle of his biggest growth spurt (I believe the last time was just a fluke). A cast was put on the first time, however a splint and walking boot were deemed sufficient the last two. He is almost 17 now, but I still worry when he plays basketball!

I'm so glad that he is able to still play his - presumably - favorite sport!

It is good that your daughter is active, and ballet certainly contributes to balance (I have a daughter who dances as well)! Hopefully she is going through a sort of "clumsy" stage, where she has not quite gotten used to how long her own limbs are (quite common for adolescents). Is she on pointe yet in ballet? In the US, my daughter's dance instructor was very particular about evaluating the apparent ankle strength of her pupils prior to letting them join pointe class. Be careful with that, given her history!
My daughter began pre-pointe exercises last fall, and did a bit of real pointe work in late spring. Several ballet dancers/teachers have said that the pre pointe work would actually strengthen her ankles, but given the situation, I'm going out to get another opinion...

Thanks!
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Old 29.08.2011, 15:37
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Re: Broken ankle #3? - now what?!

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Thanks Verbier! Just at the time my daughter was referred for physical therapy, it was time to go see the family in the States. I tried to hook her up with someone there, but he was on vacation.

You have just explained to me better than anyone why I should take her to these sessions. Physical therapy was recommended to me by some, but others argued that she is already getting plenty of strength training in her regular ballet exercises. Your explanation makes the need for physical therapy more clear. I'll see to it right away.
The difference is that I am talking about balance and re-training the proprioceptive system while someone else might have just proposed some "strength" work while not addressing the PC issue. They are two different things. When you talk with the doctor, you will need to stress that you want PC work done (especially as she has done the same thing on several occasions). This means the automatic reflex system is not operating to protect her from going over on the ankle. Yes, both the muscles and the brain need to work together. It is just a question of retraining the PC system.

She will find the physio fun as she will do some exercises on wobble boards, Bosu balls (if you go to Vidy Med) etc.

As a small test, you can have her stand on one food at a time. See how long she can keep standing on the good vs bad side. That will give you an indication if the PC system is off. To make it more difficult, she can close her eyes. Once again check the time between the sides.

Some links to read:

http://www.livestrong.com/article/21...ing-in-a-cast/

http://www.livestrong.com/article/44...p&utm_medium=2
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Last edited by Verbier; 29.08.2011 at 15:45. Reason: Corrected some wording
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Old 29.08.2011, 17:32
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Re: Broken ankle #3? - now what?!

I severely sprained my ankle 3 times, and each time I was referred to a physiotherapist for several sessions (up to 30 for the worse injury) of proprioceptive therapy. It really helps, and I would recommend it.

I saw several therapist in Lausanne, and they all know about it. I could give you a few names by pm if you wish.
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