14 January 2003

Growing pains can be serious

If your child ends up limping after a hard weekend of soccer or another intense sport, he or she may have more than a simple ankle or foot sprain. It could be a more serious growth-plate injury.

If your child ends up limping after a hard weekend of soccer or another intense sport, he or she may have more than a simple ankle or foot sprain. It could be a more serious growth-plate injury, says the American College of Foot and Ankle Surgeons (ACFAS).

Growth plates are areas of developing tissue at bone ends that regulate and help determine the length and shape of the mature bone. Growth plates are also the weakest areas of a youngster's growing skeleton.

The growth plate is the last portion of the bone to ossify, or harden, and until that happens it's weaker than nearby ligaments and tendons. An improperly treated growth-plate injury can lead to long-term consequences, including bones that are crooked or too short.

Growth-plate trauma in the foot and ankle area is common in soccer and other sports that involve lots of running, says Dr Richard Bouché, a podiatric foot and ankle surgeon.

"You're more likely to see a growth-plate injury in a kid than an ankle sprain, because the ligaments are pretty strong and the growth plates are relatively weak, says Bouché, who is chairman of the ACFAS sports medicine committee.

Bouché says parents need to make sure their children stretch before they start any sport. If a child is experiencing heel pain, reducing the amount of activity or applying ice packs to the heel after a game or practice may help, Bouchí says.

He says in some cases, anti-inflammatory drugs and shoe inserts or lifts are recommended, but the potential for recurrent injury exists until the growth plate closes.

Growth-plate injuries mimic a sprain and can be difficult to see on X-rays, but a thorough clinical exam will pinpoint the problem, says Dr Daniel Hatch, a podiatric surgeon.

"If they're tender on the growth plate, they need to be treated appropriately. Otherwise, it can have detrimental effects to that growth plate - either premature closure or angular deformities that affect the actual growth of the bone," Hatch says.

There are different treatment options. If the growth plate is aligned, it can be immobilised and protected - usually with a cast - and the injury will heal in four to six weeks.

If there's a misalignment of the growth plate, it can sometimes be manipulated back into place and protected with a cast. If it's a severe misalignment, then surgery is necessary to restore the plate to the proper position.

Many parents are unaware of growth-plate injuries. If your child is limping or has pain, swelling and discomfort around the ankle, it may indicate a growth-plate injury.

The potential for growth-plate problems ends around age 16 when the growth plates turn from cartilage into bone and stop growing.

What to do
Growth plates can be fractured in falls, sports injuries, traffic accidents or other trauma, or from chronic stress and overuse. Although common in the lower bones of the leg, many growth-plate fractures can also occur in the long bones of the finger and the outer bone of the forearm.

Here's some more information from the American Academy of Orthopaedic Surgeons:

  • Girls between the ages of 11 and 12 and 14-year-old boys are most vulnerable to growth-plate fractures.
  • Growth-plate fractures occur twice as often in boys as in girls.
  • One-third of growth-plate injuries happen in competitive sports like football, basketball or gymnastics.
  • About 20 percent of growth-plate fractures result from recreational sports like bicycling, sledding, skiing, or skateboarding.


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