Lateral ankle injuries are among the most common musculoskeletal injuries in children. Salter-Harris Type I distal fibula fractures account for approximately 3% of pediatric ankle injuries (Boutis et al. JAMA Pediatr 170:e154114, 2016). However, variability in diagnosis can lead to misdiagnosis, inconsistent treatment approaches, and increased healthcare costs. A value-based approach to managing pediatric ankle injuries can reduce unnecessary imaging, specialist referrals, and treatment variability, while improving outcomes. Careful physical examination can guide the use of radiographs, thereby lowering costs. In addition, the use of unnecessary immobilization devices such as controlled ankle motion walking boots or casts should be reconsidered, as they are expensive and can cause skin complications. Lastly, post-injury physical therapy is rarely indicated and may delay return to play. Implementing these practical strategies can help improve value in pediatric ankle injury management.