When it comes to treating children, I find it a whole new ball game compared to treating adults. Kids can be very unspecific about their pain as they haven’t developed the neurological pathways that enable them to understand pain. Quite often pain can be brushed aside as “growing pains”. But what does this mean? Is it something we should be taking seriously?
It’s important to note that pain is a very complicated sensation, and even though we often think our children are winging for the sake of it, pain is something not to be taken lightly as some serious issues can go undiagnosed.
Although the vast majority of problems may resolve in time, why would we want to leave our kids in pain when there are simple solutions to treat their pain? It’s similar to treating a cold or flu. Even though we know we’re going to be better in time, there are still get medications to treat symptoms. This blog aims to look at some of these paediatric problems seen in the lower limb as well as some other issues which should not be taken so lightly.
Growing pains =Inflammation of growth plates, areas of pain include the heel, a bony prominence just before the 5th toe, and below the knee cap
Apophysitis is an inflammation process that occurs at a growth plate. What is a growth plate? As children, most of the bones start off as cartilage. There are certain sections of bone called the growth plate where the cartilaginous bone is turned into mature adult bone. Irritation can occur at these growth plates as tight muscles causes traction around these areas. Usually occurring through a child’s growth spurt as the bone grows quicker than the muscle, it’s also very commonly seen in active children.
Common areas of apophysitis include the heel known as severs disease, the base of the 5th metatarsal called Iselins disease (see below), and below the knee cap called os-good schlatters.
Treatment focuses on releasing the tension of the muscles around these growth plates. This can include a stretching program and methods aiming to reducing the excessive movements that might cause these muscles to become taut. There are a plethora of treatments available to help us achieve this.
Usually these apophysitis conditions resolve once the bone matures and the growth plate closes. This may take years from the initial presentation. Pain may also present when the child becomes physically active and may follow the sporting seasons.
The above conditions are quite common in children. However, there are certain areas of pain that SHOULD NOT BE MISSED and REQUIRE URGENT DIAGNOSES! If your child experiences pain in the arch or ball of the foot, or again just behind the 5th toe, seek medical attention straight away! These high risk areas usually have a low blood supply, which means healing can be slow and may even cause the bone to die. Conservative treatment will look at deflecting pressure away from these areas as well as reducing unnecessary movement. However more aggressive treatment could require the use of a camwalker or even a surgical opinion. A list of these conditions are listed below
- Kholers disease which is usually a pain located to the arch of the foot
- Freiberg’s disease which is located on the 2nd “knuckle” of the foot/ the ball of the foot
- 5th metatarsal avulsion fracture which commonly occurs during an ankle sprain, located just behind the 5th toe
Again it is important that we listen to our children. Many adults face benign musculoskeletal injuries, but are able to articulate their pain appropriately. Children are much more complex. It’s important to have a professional check them out to ensure nothing serious is going on. Remember, your child may grow out of these issues, but it may take years. Also remember to not miss or neglect specific areas of pain as these areas may be high risk areas and require urgent medical attention!