Apophysitis and Growth Plate Fractures
- What is a growth plate? Growth plates are sections of cartilage in the bones of children which transition into bone when they are done growing.
- How can a growth plate be injured or fractured? While ligaments are the weakest point in the kinetic chain for adults, in children it’s the growth plates. With children being active in gym class and sports, it is not uncommon for the growth plates to be injured or aggravated. The most common area for growth plate irritation (called apophysitis) is in the heel. Because growth plates play a part in where insertion of muscles occurs, increased activity can cause micromotion at the growth plate and it can become inflamed. Excessive activity can also cause growth plate fractures, but these also occur in instances where the foot, ankle or leg is sprained from landing improperly from a jump or during running.
- How do I know if my (son/daughter’s) growth plate has been injured? Your doctor will perform a thorough physical examination and get x-rays to determine whether a fracture has occurred or if there are any other abnormalities within the bone. As growth plates naturally appear irregular, it is often necessary to get an x-ray of both feet and ankles.
- What can be done to treat these? Because a growth plate is aggravated from excessive activity, the key to treating these is rest. Rest allows the growth plate to heal itself and calm down from the previous irritation. In order to adequately rest a growth plate, your doctor will recommend either a brace, flat soled shoe, or boot. This is to aid in resting the growth plate, while allowing the child to continue to walk. They will likely need to be excused from gym class and extracurricular sports while in the brace/shoe/boot. If the initial treatment does not adequately reduce pain within a couple of weeks, casting is another option. Casting can immobilize or rest a growth plate more effectively than a walking boot. Unna boots are another option to soothe aggravated growth plates, and these have often been referred to as a soft cast. Unna boots are applied by your doctor and can be removed at home 4 days later. In instances where an actual fracture of the growth plate has occurred, x-rays will indicate the severity of the fracture. In some instances, fractures of growth plates need to be surgically reduced to normal alignment and splinted with pins. If the growth plate fracture has not displaced (or moved out of position), immobilization is again key. Depending on the location of the injury, your doctor may also recommend the child not bear weight on the affected limb and use crutches to get around.
If treated quickly and aggressively, these conditions can resolve in as little as 2 weeks. Delayed treatment can result in longer recovery time. While being out of sport, dance or gym class can be frustrating, the alternative can worsen the condition, cause abnormal growth of bones and lead to chronic issues for the child.