Introduction
During growth and development children experience change hormonally, cognitively, biologically and physically. This change is rapid and requires the body to adapt and reorganise its response to stimuli. Musculoskeletally, this can result in children experiencing unique conditions during their transition into adulthood. Below is a brief summary of conditions affecting the adolescent foot.
Sever’s Disease (Calcaneal Apophysitis): Is a condition in which a child experiences heel pain as a consequence of inflammation of the growth plate from excessive load. Risk factors for Sever’s disease include; higher body mass index, increased height compared to peers and excessive foot pronation (flat feet). Children who are older or have reported pain for a long period of time typically experience elevated pain levels reinforcing the need for early intervention (James, Williams, Luscombe, Hunter & Reshele-Haines, 2015).
Kohlers Disease: Is a condition disrupting the blood supply to a small bone on the inside of the foot, known as the navicular. Children typically report foot pain and may demonstrate and a limp. Although the cause of Kohler’s disease is unknown, it has been identified as being more prevalent in the males between 2-8 years of age. This condition is referred to a self limiting as it spontaneously resolves over time (Atanda, Suken & O’Brien, 2011).
Freiberg’s Disease: Is a condition causing a disruption of blood flow to the head of the second metatarsal. Presentation can vary from mild pain after activity to pain and difficulty with walking. The cause of Freiberg’s disease remains unknown, however increased trauma, poor blood supply and joint stiffness in the second and third tarsometarsal joints have been identified as potential risk factors. Removing load and correcting biomechanics should encourage regeneration of the metatarsal head and a gradual resolution of symptoms (Atanda, Suken & O’Brien, 2011).
Tarsal coalition: Is a condition in which two or more bones of the middle or back of the foot are joined by either bone or cartilage (typically calcaneonavicular or talocalcaneal). Children typically report pain in their middle and hind foot in addition to demonstrating rigid flat feet and tight calf muscles on clinical assessment. Tarsal coalition is more prevalent in children aged between 9-14 years of age and should be confirmed by X-ray or CT scan. Conservative treatment for tarsal coalition is recommended to restore foot ROM however an orthopaedic consult may be required if conservative management is ineffective (Zhou, Tang and Hardy, 2014).
Conclusion
Children and adolescents are not small adults, they are susceptible to a unique group of conditions that occur throughout growth and maturity. Children experiencing foot pain require a review by a health care professional to guide diagnosis and treatment.
References
Atanda, A., Shah, S., & Obrien, K. (2011). Osteochondrosis: Common causes of pain in growing bones. American Family Physician, 83(3) 287-291.
James, A., Williams, C., Luscombe, M.,& Reshele-Haines, T. (2015). Factors associated with pain severity in children with calcaneal apophysitis (Sever’s Disease). Journal of Pediatrics, 167(2), 455-459.
Zhou, B., Tang, K., & Hardy, M. (2014). Talocalcaneal coalition combined with flatfoot in children: Diagnosis and treatment: A review. Journal of Orthopaedic Surgery and Research, 129(9), 1-8.
