Our 10-year-old boy broke his ankle while out skateboarding. I knew it was only a matter of time before something happened. He’s an accident waiting to happen. Now he’s in a cast but everyday he tells me his big toe feels numb and he can no longer wiggle it like they showed him to do at the hospital. What could be causing this?

Any new symptoms after a fracture and especially in someone who has been placed in a cast should be reported to the physician immediately and evaluated. Not all fractures show up on X-rays and soft tissue damage doesn’t show at all so further evaluation is important at this time.

It is possible that the cast is too tight. Swelling may put pressure on the local blood vessels and nerves causing additional symptoms. A special tool called a Doppler can be used to test arteries for adequate blood flow. The treatment may be as simple as taking the cast off and recasting.

X-rays and possibly CT scans may be advised to check the status of the healing fracture and to look for any other potential causes for these new symptoms. One of the biggest concerns for children with ankle fractures is the risk of damage to the growth plate called physeal arrest. Surgeons evaluating children with physeal fractures of the lower leg bones (tibia and fibula) must be very careful to identify the specific type of fracture and all other areas that might also be injured (e.g., soft tissues such as cartilage, tendons, ligaments).

Successful treatment depends on an accurate diagnosis. Placing a child in a leg cast when there is a large gap in the bone can result in pain and failure to heal. A swollen muscle trapped between the bone and another anatomic part or a piece of flap of bone jammed in the fracture space must be surgically removed before fracture healing can occur.

It might be best to pick up the phone and place a call today to the orthopedic surgeon or other physician who treated your son initially. Someone from that hospital, clinic, or office will be able to advise you what to do.