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Splinting Series Part 2: Lower Extremity

Author: Kayla Darris, MD
Peer-Reviewer: Mark Hopkins, MD, CAQ-SM; Matthew Negaard, CAQ-SM
Final Editor: Alex Tomesch, MD, CAQ-SM

A 5 year old presents to the ED with significant pain and inability to bear weight on his right leg after twisting attempting to catch a ball while playing with his brothers. On exam, he has pain and swelling over the distal tibia and is neurovascularly intact.


 Image 1. Xray of the left foot. Case courtesy of Fadi Ali,, rID: 84977




[1] Wang Y, Doyle M, Smit K, Varshney T, Carsen S. The Toddler's Fracture. Pediatr Emerg Care. 2022 Jan 1;38(1):36-39. doi: 10.1097/PEC.0000000000002600. PMID: 34986580.

[2] Patel NK, Horstman J, Kuester V, Sambandam S, Mounasamy V. Pediatric Tibial Shaft Fractures. Indian J Orthop. 2018 Sep-Oct;52(5):522-528. doi: 10.4103/ortho.IJOrtho_486_17. PMID: 30237610; PMCID: PMC6142797.

[3] Boyd AS, Benjamin HJ, Asplund C. Splints and casts: indications and methods. Am Fam Physician. 2009 Sep 1;80(5):491-9. PMID: 19725490.

[4] Denq, W., & Hockstein, M. (2020, August 8). Splinter series: Common ed splint techniques 104. ALiEM. 

[5] Tintinalli, J., Ma, J., Yealy, D., Meckler, G., Joseph, S., Cline, D., & Thomas, S. (Eds.). (2020). Tintinall’s emergency medicine: A comprehensive study guide (9th ed.). McGraw Hill.

[6] Sprouse RA, McLaughlin AM, Harris GD. Braces and Splints for Common Musculoskeletal Conditions. Am Fam Physician. 2018 Nov 15;98(10):570-576. PMID: 30365284.

[7] Bica D, Sprouse RA, Armen J. Diagnosis and Management of Common Foot Fractures. Am Fam Physician. 2016 Feb 1;93(3):183-91. PMID: 26926612.

[8] Matthew Negaard, M. (2019, October 31). Splinter series: A toddler’s missed step. ALiEM. 





Soft Tissue Knee Injuries

Splinting not recommended

Patellofemoral Pain: Patellar stabilizing brace

Patellar Tendinopathy: Patellar tendon strap

Ligamentous/Meniscus Injury: Hinged knee brace

Patella Fractures

Posterior Knee Splint

Knee Immobilizer 

Proximal Tibia/Fibula Fracture

Posterior Long Leg


Distal Tibia/Fibula Fracture

Posterior Short Leg


High Ankle Sprain

Stirrup (not preferred)

Boot, Soft Lace-Up or Semi-rigid Air Brace

Tarsal Fracture

Posterior Short Leg


Metatarsal Fracture

Posterior Short Leg

High-top walking boot, Post-op shoe

Phalanx Fracture

Posterior Short Leg

Buddy taping, High-top walking boot, Rigid Sole Shoe

Appendix A: Quick Reference Guide for appropriate splint selection in lower extremity injuries [3-7]





Functional Position

Posterior Knee Splint

Quadriceps or patellar tendon rupture, Patellar Fracture or unstable dislocation

Just below the gluteal crease

Just proximal to the malleoli

Knee in 10 to 20 degrees of flexion

Posterior Long Leg

Proximal tibial fractures (including tibial plateau fractures), pediatric femoral shaft fractures

Just below the gluteal crease

Plantar surface of the distal metatarsals

Knee in 5 to 10 degrees of flexion, ankle at 90 degrees of flexion

Posterior Short Leg

Distal tibia/fibula fractures, tarsal fractures, metatarsal fractures, lisfranc injuries, phalanx fractures, high grade ankle sprains

2 inches below the femoral head (to avoid compression of the common peroneal nerve)

Plantar surface of the distal metatarsals

Ankle at 90 degrees of flexion *In Achilles ruptures or Dancer's fractures, the position of functions is the Equinus position

Ankle Stirrup

Isolated malleolar fractures, high grade ankle sprains, reduced ankle dislocations

At least 2 inches below the femoral head (to avoid compression of the common peroneal nerve)

Extension underneath the plantar surface of the foot, with return to the origin on the medial side of the leg

Ankle at 90 degrees of flexion

Appendix B: Quick Reference Guide for correct positioning of lower extremity splints [3-6]