Foot Health Highlight: Pediatric Foot Injury and When to Be Concerned About Damage to Your Child’s Growth Plate
Whenever podiatrists hear of a child suffering from an injury, we automatically worry about possible damage to growth plates. It’s a legitimate concern that needs to be thoroughly evaluated upon presentation to the doctor. When dealing with lower extremity injuries the podiatrist will typically x-ray and clinically evaluate the injury to determine if the area in and around the growth plate is affected, or if the injury has directly disrupted the growth plate itself. The treatment plan changes from initial management to the possibility of surgical management and the choice of fixation (pins/screws etc) that can be utilized depending on the extent of growth plate involvement.
When understanding a pediatric injury versus the same injury in an adult, there are some important differences to consider. In kids, the bones are very malleable, meaning that the tendons and ligaments surrounding the bones are stronger than the actual bones themselves. Therefore, in a pediatric patient injury is likely to lead to bone injury — versus in an adult where ligament damage is more likely. Secondly, treating injuries or fractures in the pediatric patient is much more complicated because of the presence of the growth plate.
Growth plates in the lower extremity, when visualized on x-ray, indicate that growth of the individual is still possible. When evaluating bones on x-ray, there are specific “zones” that can be identified to signify growth, disruption of growth, and healthy bone. During infancy, the bones are very soft and malleable. They only harden (ossify) and change completely into solid bone in a child’s mid to late teens, sometimes not until their early twenties. What this means is that injury anywhere in the body, before ossification takes place, can affect growing bone with the possibility of disrupting growth, causing abnormal/irregular growth and even potentially halting growth altogether.
In an adult, the growth plate has closed, growth has ceased, and treatment of a fracture can be initiated without fear of interrupting growing bone. If pins, screws, or plates are needed for fixing the adult fracture, they can be applied without reservations or worries of disrupting growth. However, in pediatric patients certain types of fixation must be avoided and others used carefully and in specific ways so as to protect the growth plate and allow for normal growth to continue.
When the growth plate is unaffected, fracture management is still tricky, but can be more easily handled and the growth plate more easily avoided during treatment. When fracture across the growth plate is created by the initial injury, the goal of fracture management becomes more complicated as the growth plate cannot be avoided during treatment. It must be addressed with reduction and fixation bringing the edges of the fractured growth plate into close proximity with one another. Doing so decreases the risk of interrupted or halted growth in the affected bone with the hope that restoration of normal growth occurs.
Pediatric fractures can be complex, but they can be treated in such a way as to minimize disruption to normal growth patterns. It is important to seek treatment immediately if fracture is suspected, but refrain from pondering the worst-case scenario until your child has been evaluated!