Care of the youth athlete requires knowledge of developmental anatomy and specific injury patterns, which are acute or chronic in nature. We may expect that the incidence of overuse and acute foot and ankle injuries in this population is likely to increase in proportion to the number and intensity of competitive youth teams with demanding training schedules. We, as physicians, must exercise our best judgment in regard to recognizing these patterns early and instituting appropriate treatments. Return to play decisions should be based on objective criteria when available and always keeping the best interest of the athlete's future health in the forefront of our minds.