There are a few growth plate conditions that are common among children.
These conditions are particularly common between the ages of 2 and 16.
These conditions can be grouped together under the name of ‘Osteochondroses’.
What are growth plates?
Growth plates are located at the end of long bones and are where bone growth takes place.
Growth plates are also known as the epiphyseal plate. They fuse together between the ages of 15-18 for girls and 18-22 for boys.
Once these growth plates are fused, you will stop growing.
Growth plates are susceptible to injury, particularly in active children.
They can be painful due to a few different factors:
- Macrotrauma – such as in a collision during sport or play.
- Microtrauma – overuse injury such as from playing many sports.
- Growth spurts – this can also result in pain in the surrounding soft tissue such as muscles.
In addition to growth plates, there is another area on some bones called the ‘apophysis’, where a tendon attaches to the growth plate. These areas can become irritated when the tendon is continuously under traction or pulling forces. This commonly affects the front of the knees and the heels.
Common growth plate conditions
Keep reading to learn about some of the common growth plate conditions that can affect children.
Kohler’s disease
Kohler’s disease is a condition that affects the navicular bone, which is located in the midfoot.
The navicular is the last bone of the foot to harden or ‘ossify’, which happens between the ages of 3-5.
Kohler’s disease most commonly affects children aged 2-8 and is more common in boys than girls.
Children’s with Kohler’s disease will often begin complaining that they cannot put weight through the foot and begin limping.
Pain may also be present when pressure is placed on the navicular such as in footwear, and significant pain is usually present when the area is palpated.
Kohler’s disease is diagnosed via an MRI. The navicular bone does not have the best blood supply, therefore scans may show a degree of what is called avascular necrosis, meaning death of the bone due to a lack of blood flow. Therefore, it is important that Kohler’s disease is treated as early as possible.
Treatment of Kohler’s disease includes:
- The use of a moon boot/CAM walker – this will allow the foot to be offloaded to allow for healing.
- Orthotic therapy – this will help to align the foot in the correct position, as well as take the pressure of the navicular to avoid further or future injury.
- Footwear – supportive footwear is extremely important for the health of your feet.
Learn more about other midfoot and rearfoot conditions here.
Sever’s disease
Also known as calcaneal apophysitis, Sever’s disease affects the heel and is considered to be the most common of the osteochondroses.
It is common in active children aged between 8-14 and can present as a dull ache in the heels, particularly after sport.
Learn more about calcaneal apophysitis here in our article – “Heel pain in kids – what does it mean?“.
Iselin’s disease
Iselin’s disease affects the base of the 5th metatarsal, also known as the styloid process.
Commonly affecting kid’s aged 10-14 years, this particular condition involves injury and inflammation at the apophysis.
There are two soft tissue structures that attach onto this part of the foot. It can be damaged through repeated traction forces by these soft tissue structures.
This particular bone of the foot is also susceptible to fractures, including in a lateral ankle sprain, therefore it is very important to correctly diagnose this condition.
Children with Iselin’s disease will experience pain through the outside of the foot and X-rays can be performed to confirm the diagnosis.
Treatment of Iselin’s disease includes:
- Stretching of the muscle on the outside of the leg that inserts onto the styloid process (known as peroneus brevis). Tightness through this muscle may be a contributing factor.
- RICE – to assist with pain and inflammation.
- Proper footwear – ensure that footwear is wide enough to avoid irritation through this area.
- Orthotic therapy – if the child has a pes cavus foot type (high arches), more pressure will be placed on this area. Orthotic therapy can help to align the feet and reduce this pressure.
Freiberg’s infraction
Freiberg’s infraction is a condition that affects the head of the 2nd metatarsal, however, it can also occur at the 3rd and 4th metatarsals.
It generally occurs in physically active children between the ages of 12-15 and is more common in girls.
It is diagnosed through an X-ray or MRI and shows that instead of the bone being curved, it appears flat.
Having a longer second toe is a common risk factor for Freiberg’s infraction.
Treatment options for Freiberg’s infraction includes:
- RICE – initially, this will assist in pain reduction.
- Footwear modifications – the aim is to ensure that the toe box of the shoe has adequate depth and width to avoid excessive pressure through the forefoot.
- Orthotics – this can be used to redistribute the pressure away from the area and to provide cushioning.
- Stretching of the calf muscles – when the calf muscles are tight, we tend to spend more time on the forefoot. By stretching these muscles, less pressure is placed on the forefoot.
If your child is experiencing any of the pain or discomfort that we have talked about today, come see us at Watsonia Podiatry. We’re here to help the health of your child’s feet and yours! You can book an appointment to see us online here, or you can call us on 03 9432 2689.