Ankle Instability in Pediatric and Adolescent Patients: Juvenile Broström-Gould Outcomes

Medically reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatric Surgeon — Balance Foot & Ankle, Howell & Bloomfield Hills, MI. Last updated April 2026.

Chronic lateral ankle instability (CLAI) in pediatric and adolescent patients — recurrent ankle giving-way from lateral ligament incompetence following multiple inversion sprains — presents unique management challenges compared to adults due to open physes, physiologic ligamentous laxity, skeletal immaturity, and the critical importance of maintaining physeal integrity during surgical repair. The modified Broström-Gould procedure is safe and effective in skeletally immature patients when performed with physeal awareness, and provides excellent functional outcomes allowing return to competitive sports — with recurrence rates comparable to or lower than adult populations when appropriately indicated.

Pediatric Ankle Anatomy and Special Considerations

Physeal anatomy relevant to ankle surgery: the distal fibular physis is located approximately 1.5–2cm proximal to the fibular tip in adolescents; the distal tibial physis closes at age 14–17 in girls and 16–18 in boys; suture anchor placement for Broström repair must avoid the fibular physis to prevent growth arrest and angular deformity. Physiologic laxity in children: children and adolescents normally have greater joint laxity than adults — Beighton hypermobility score >5 is common in pediatric dancers and gymnasts and does not preclude Broström when instability is anatomically confirmed. Differential diagnosis in pediatric ankle pain: osteochondral lesion of the talus, peroneal tendon tears (rare in children), and coalition (subtalar or talocalcaneal) must be excluded before CLAI diagnosis is confirmed. Indications for pediatric CLAI surgery: CLAI confirmed by clinical stress examination and/or stress fluoroscopy; minimum 3–6 months of compliant PRICE + peroneal strengthening rehabilitation program failure; ongoing functional instability limiting school activities and sport.

Juvenile Broström-Gould Technique and Outcomes

Modification for open physes: suture anchor placement confirmed fluoroscopically to remain distal to the fibular physis; the proximal Gould augmentation suture to the inferior extensor retinaculum poses no physeal risk; anchor trajectory directed distally and slightly anteriorly to maximize distance from the physis. Technique: standard Broström-Gould (ATFL reattachment to fibula with inferior extensor retinaculum augmentation) — identical to adult except for physis awareness; no InternalBrace augmentation concerns in most pediatric cases (fibular InternalBrace anchor placement is well distal to the physis). Outcomes: pediatric Broström — 87–95% good-excellent functional outcomes at 2–5 year follow-up; return to sport at 4–5 months; recurrence rate 5–10% (comparable to adult); no reported physeal growth arrests with proper technique; hypermobile patients (Ehlers-Danlos) have higher recurrence and require augmentation. Dr. Biernacki at Balance Foot & Ankle evaluates pediatric and adolescent ankle instability and performs juvenile Broström-Gould repair at our Bloomfield Hills and Howell offices. Call (810) 206-1402.

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Frequently Asked Questions

How do I know if I sprained or broke my ankle?

Both cause pain, swelling, and difficulty walking. Key differences: fractures often cause more immediate severe pain, tenderness directly over bone (not just ligament), and inability to bear any weight. X-rays and the Ottawa Ankle Rules help determine if imaging is needed.

How long does an ankle sprain take to heal?

Grade I (mild): 1–2 weeks. Grade II (moderate): 3–6 weeks. Grade III (complete tear): 2–3 months. Chronic instability from improperly treated sprains can persist and may require surgery.

What is the best treatment for a sprained ankle?

RICE protocol (Rest, Ice, Compression, Elevation) for the first 48–72 hours, followed by protected weight-bearing as tolerated. Physical therapy rehabilitation is critical for high-grade sprains to restore strength and proprioception and prevent chronic instability.

Need Treatment at Balance Foot & Ankle?

Dr. Tom Biernacki, Dr. Carl Jay, and Dr. Daria Gutkin see patients at our Howell and Bloomfield Hills offices.

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Most Common Mistake We See

The most common mistake we see is: Waiting too long before seeking care. Fix: any foot pain lasting more than 4 weeks, or any sudden severe symptom, deserves a professional evaluation rather than more rest.

Warning Signs That Need Same-Day Care

Frequently Asked Questions

When should I see a podiatrist?

If symptoms persist past 2 weeks, affect your normal activity, or are accompanied by red-flag symptoms (warmth, redness, swelling, inability to bear weight).

What does treatment cost?

Most diagnostic visits and conservative treatments are covered by Medicare and major insurers. Out-of-pocket costs vary by your specific plan.

How quickly can I get an appointment?

Most non-urgent cases see us within 5 business days. Urgent cases (sudden pain, possible fracture) typically same or next business day.

In-Office Treatment at Balance Foot & Ankle

If home treatment isn’t providing relief for your ankle conditions, our podiatry team at Balance Foot & Ankle can help with same-day evaluations and advanced in-office care.