- [Home](https://ortopediaevolutiva.com/en) - [Pediatric Orthopaedics Blog — Dr. Priano](https://ortopediaevolutiva.com/en/blog) - Low-risk ankle fractures in children: removable brace, cast, and return to activities # Low-risk ankle fractures in children: removable brace, cast, and return to activities February 6, 2026 2 min read Edited and medically reviewed by [Dr. Daniele Priano](https://ortopediaevolutiva.com/en/about) ![Low-risk ankle fractures in children: removable brace, cast, and return to activities](https://ortopediaevolutiva.com/blog-images/fratture-caviglia-basso-rischio-bambini-boot-tutore-vs-gesso-neutral-v1.webp) This English version is based on the original Italian article. For wording nuances, you can refer to the Italian version. ## In short, for parents - • In the selected stable, low-risk ankle injuries studied, removable braces allowed an earlier return to activity than casts. - • Unscheduled visits were less frequent; there was no significant difference in complications. - • These findings do not apply to all ankle fractures: the injury type, weight-bearing and return to activity need to be assessed by the treating clinician. In stable, low-risk pediatric ankle injuries, rigid immobilization is not always necessary. Several trials have compared casts, removable braces, and bandages, with results favoring strategies that allow earlier mobilization. [1][2][4] ## What the 2026 meta-analysis shows The review by Badhe and colleagues included 7 randomized trials and 503 children with low-risk fractures, stable injuries, or suspected occult fractures managed non-surgically. [1] Compared to casts, removable braces were associated with fewer unscheduled visits, with an RR of 0.26, and a return to activities approximately one week faster on average. Functional scores and satisfaction for both children and families were also better. [1] In the included trials, there were no significant differences in pain or complications between the strategies within the low-risk categories selected. [1] ## Previous data An RCT published in *Pediatrics* in 2007 had already shown better functional recovery at 4 weeks and a faster return to activities with a removable brace compared to a cast. [2] In 2016, another study evaluated children with lateral ankle pain and negative radiographs. True Salter-Harris I fractures of the distal fibula were rare; more often, MRI showed ligamentous sprains or small occult avulsions. Children treated with a removable brace and symptom-guided return to activities had a similar course even when MRI revealed an occult bone injury. [3] A systematic review from 2019 had already reached conclusions favoring early mobilization, while highlighting the heterogeneity of definitions and protocols. [4] ## The role of bandaging A feasibility trial from 2025 compared supportive bandages, removable splints, and weight-bearing casts in children aged 5 to 15 years. [5] A definitive comparison is still needed to establish the minimum effective device for different subgroups. ## Cases requiring caution These results do not apply to all pediatric ankle fractures. Displacement, instability, joint involvement, certain physeal injuries, and more significant clinical presentations require different treatment. In truly low-risk cases, however, a removable brace can offer sufficient protection with less stiffness and faster recovery. The choice depends on the correct identification of the injury type and clear instructions regarding weight-bearing, pain, and return to activity. Disclaimer Informational content; does not replace individual clinical evaluation. ## References [1] Badhe N, et al. Outcome of ankle fractures in children: an updated systematic review and meta-analysis. Ann R Coll Surg Engl. 2026. PMID: 41622914. PubMed: [https://pubmed.ncbi.nlm.nih.gov/41622914/](https://pubmed.ncbi.nlm.nih.gov/41622914/) [2] Boutis K, et al. A randomized, controlled trial of a removable brace versus casting in children with low-risk ankle fractures. Pediatrics. 2007. PMID: 17545357. PubMed: [https://pubmed.ncbi.nlm.nih.gov/17545357/](https://pubmed.ncbi.nlm.nih.gov/17545357/) [3] Boutis K, et al. Radiograph-Negative Lateral Ankle Injuries in Children: Occult Growth Plate [Fracture](https://ortopediaevolutiva.com/en/conditions/injuries-fractures) or Sprain? JAMA Pediatr. 2016. PMID: 26747077. PubMed: [https://pubmed.ncbi.nlm.nih.gov/26747077/](https://pubmed.ncbi.nlm.nih.gov/26747077/) [4] Marson BA, et al. Management of ‘low-risk’ ankle fractures in children: a systematic review. Ann R Coll Surg Engl. 2019. PMID: 30855167. PMCID: PMC6818065. PubMed: [https://pubmed.ncbi.nlm.nih.gov/30855167/](https://pubmed.ncbi.nlm.nih.gov/30855167/) Full text: [https://pmc.ncbi.nlm.nih.gov/articles/PMC6818065/](https://pmc.ncbi.nlm.nih.gov/articles/PMC6818065/) [5] Marson BA, et al. Supportive bandage, removable splint, or walking casts for low-risk ankle fractures in children: a feasibility randomized controlled trial. Bone Joint J. 2025. PMID: 39740682. ## Complete injuries and fractures pathway This page is part of the paediatric injuries and fractures pathway. The main guide covers the overall picture and the warning signs. - [1 Overview: when an injury is urgent How growing bone behaves, what happens in the emergency room and when an orthopaedic review is useful.](https://ortopediaevolutiva.com/en/conditions/injuries-fractures) - [5 Lower limb and ankle Femur, leg, knee and ankle: weight-bearing, healing times and return to walking.](https://ortopediaevolutiva.com/en/conditions/femur-fracture-children) [Leg](https://ortopediaevolutiva.com/en/conditions/leg-fracture-children) - [Ankle](https://ortopediaevolutiva.com/en/conditions/ankle-fracture-children) - [Knee injury](https://ortopediaevolutiva.com/en/conditions/knee-injury-children-adolescents) - [Tibial spine](https://ortopediaevolutiva.com/en/conditions/tibial-spine-fracture) - [Ankle surgery](https://ortopediaevolutiva.com/en/surgery/fractures/ankle) - [Foot surgery](https://ortopediaevolutiva.com/en/surgery/fractures/foot) - [6 Imaging, cast and follow-up Growth plate, follow-up X-rays and management of immobilization.](https://ortopediaevolutiva.com/en/conditions/physeal-fractures) - [7 Recovery and protocols How recovery works after injury or surgery; protocols are professional material.](https://ortopediaevolutiva.com/en/rehabilitation) ![Dott. Daniele Priano](https://ortopediaevolutiva.com/assets/doctor-avatar-3d-CTvqnoPa.webp) ### Concerned about your child? If you recognize any of these signs in your child, a specialist assessment can give you clarity. I see children at Gaetano Pini and CTO institutes in Milan. 5.0 · Google & MioDottore [Book a private visit](https://ortopediaevolutiva.com/en/locations#prenota) ### Related Conditions [Fractures and trauma](https://ortopediaevolutiva.com/en/conditions/injuries-fractures) ### Related Surgery Pages [Fracture treatment](https://ortopediaevolutiva.com/en/surgery/injuries-fractures) ### Related Articles [Medial malleolus fractures in children: is the risk of growth arrest really that high? Read](https://ortopediaevolutiva.com/en/blog/medial-malleolus-fractures-children-growth-arrest)[Ankle sprain and distal fibula avulsion in children: recovery and return to sport Read](https://ortopediaevolutiva.com/en/blog/childhood-ankle-sprain-return-to-sport)[Toe walking: when to consider surgery and what we know about recurrence in autism Read](https://ortopediaevolutiva.com/en/blog/toe-walking-when-surgery-recurrence-autism) ![Dott. Daniele Priano](https://ortopediaevolutiva.com/assets/doctor-avatar-3d-BiLSxBxW.webp) Author and medical reviewer ## Dr. Daniele Priano [Pediatric orthopaedic care in Milan](https://ortopediaevolutiva.com/en) — Gaetano Pini & CTO [Read full bio](https://ortopediaevolutiva.com/en/about) --- Canonical: https://ortopediaevolutiva.com/en/blog/low-risk-ankle-fractures-in-children Le informazioni cliniche sono divulgative e non sostituiscono una valutazione medica diretta.