Ankle pain in children can be caused by traumatic injuries to bone, ligament, or tendon or by nontraumatic conditions, such as congenital and developmental anomalies, infections and other inflammatory disorders, neural compression, metabolic derangements, and neoplasia. Evaluation of children with this complaint should include a focused history and an anatomically oriented physical examination. Depending on the findings, further diagnostic workup and laboratory evaluation should be done. Appropriate treatment-whether casting, surgery, antibiotic therapy, or a combination thereof-can then be selected on a rational basis.