Children are different from adults in many ways. The most readily apparent way in which they are different is that they really grow! Their bone structure is quite different with the presence of growth plates at the ends of many bones. These lend themselves to a variety of different problems that may occur. One is that a whole separate set of fracture classifications are needed for children, because of the diverse ways in which these growth areas may be injured.
The second major type of problem that occurs is called osteochondroses. This is a particular type of damage to a growth site. It may occur at a joint site in which case it is called an “articular osteochondrosis”. At sites at which a joint does not occur, this problem is called a “non-articular osteochondroses”. It may occur at tendon attachments, ligament attachments or in areas that receive a lot of impact stress. In clinical practice, it is most frequently seen at the sites of tendon attachment particularly the tibial tuberosity (Osgood-Schlatter’s disease) and at a site of both impact stress and tendon attachment – the calcaneus (Severs disease). Theory holds that both overuse and tight muscles may contribute to the problem. On X-ray the epiphysis (portion of bone attached to the rest by a growth plate) frequently reveals a fragmentation.
Osgood-Schlatter’s disease is an osteochondrosis that occurs at the tibial tuberosity at the site of insertion of the patellar tendon. It is manifested by a pain and a usually a bump at top of shinbone below the knee cap. Repetitive contractions of the quadriceps muscle is thought to be a contributing factor. This is seen most often in children aged 9 to 15 years. It is usually self-limited. The usual recommendation is for rest until symptoms abate, with appropriate biomechanical correction (Orthotics).
Sever’s Disease (Calcaneal Apophysitis) is a disorder of the growth plate of the calcaneus. Symptoms most often occur at the posterior aspect of the growth plate, but sometimes occur at the plantar aspect. The Achilles tendon attaches to the posterior aspect of the growth plate and the plantar fascia takes part of its origin from the plantar aspect. Clinically this occurs more often in boys than girls. The age of onset is usually between 8 to 12 years. Pain is usually related to activity levels. In most cases the posterior aspect of the calcaneus will be tender. Occasionally, the plantar aspect may be tender or both of these locations may be found to be tender. Frequently the Achilles tendon is tight and there may have been a recent increase in activity. The factors contributing to this disorder are similar to those causing plantar fasciitis, a tight achilles tendon appears to be as great a contributor as pronation. Recommendations for treatment are usually for rest or significant decrease in activity level. Although, it is often stated to be self-limited the period of time in which it becomes limited may be a bit longer than many people would wish. We recommend a decrease inactivity and usually recommend the use of a heel lift/orthotic device. After symptoms have diminished We start a gentle posterior muscle group stretching program.
Frieberg’s Disease is more common in women than in men. It is classified as an osteochondroses and as such affects the epiphysis or end part of the bone just before and at the joint. On X-ray it appears as a flattening of the metatarsal head. It usually occurs at adolescence, starting between ages 11 and 17. A review of the literature cited by David Katcherian, in an article entitled, “Treatment of Freiberg’s Disease”, Clinical Orthopedics and Related Research, January 1994, concluded the aggregate average female:male ratio was approximately 5:1. It occurs most often in the second metatarsal head, less often in the third and even less often in the fourth, fifth and first. When it is first noticed there is usually pain and limited motion at the metatarsal-phalangeal joint. The pain is aggravated by moving the affected joint. There may also be swelling and tenderness in this area. There is no definitive treatment for this condition. A decrease in activity and occasionally casting may be considered to reduce acute pain. Shoe modifications, such as rocker sole or orthotics are used to diminish stress at the affected metatarsal join are used as conservative treatment.