Pediatric Foot and Ankle Sprains May Be a More Complex Growth Plate Injury

By Dr. Carlo A. Messina

Injuries to the growth plate in children may cause damage to the structures at the end of the bone that will allow the child’s bone to grow to full adult size. X-rays can fail to provide a complete and accurate picture of the diagnosis. These injuries may be misdiagnosed as a simple sprain of the foot or ankle. However, a more complex injury may be present.  

Growth plates, which start to close between the ages of 13 and 18, can be damaged in incidents such as simple falls, sports injuries, automobile accidents or other major or minor trauma. If not recognized and treated early, a child’s growth plate injury can lead to shortening of the bone (growth ceases) as the growth plate may close prematurely. Angular deformities of the bone (a curve) may also develop. The severity of these deformities depends on the age at the time of injury, extent of the injury and the part of the growth plate that has been damaged. Certain portions of the growth plate may be injured affecting its growth while other parts grow more normally thus causing a bowing of the bone.

Symptoms of a growth plate injury may mimic a sprain. These injuries occur more frequently than realized. There will always be pinpoint tenderness on the bone’s growth plate and a degree of swelling that is proportional to the degree of injury to the area. The child will often limp and try to avoid the body part. Normal treatment for a sprain may involve simple observation and application of an ace bandage or brace. This treatment for a growth plate injury that is severe may be devastating.

X-rays are used to evaluate bone and joint alignment. A growth plate can be injured or even fractured with a normal X-ray. In more moderate to severe cases, x-rays will usually show the fracture. When in doubt, a CT scan may be necessary.  

Treatment options include:

1. Immobilization in a below-the-knee cast with or without crutches may be necessary if the growth plate is well aligned. These injuries will heal on their own within six to eight weeks. The younger the child, the faster it heals.  

2. If the injury has caused misalignment of the growth plate it can sometimes be carefully manipulated back into place and then protected with a cast. The cast would be necessary for a minimum of six to eight weeks. Nonweightbearing would be mandatory.  

3. If the misalignment is more severe and not able to be manipulated back into its normal position, surgery would be necessary to restore the growth plate to its proper position. This may help avoid later problems including malalignment or premature growth plate closure that may cause the extremity to be shortened and crooked.

The most important thing is immediate diagnosis and treatment.

  • Carlo A. Messina, DPM, is a Board Certified Reconstructive Foot and Ankle Surgeon, Diplomate American Board of Foot and Ankle Surgery. He is a Foot and Ankle Surgeon with the Foot, Ankle and Leg Specialists of South Florida and specializes in treating infants, children, teens and adults. His partners are Dr. Robert Sheinberg, Dr. Al DeSimone, Dr. Fernando Moya, Dr. Alexander Bertot, Dr. David Shenassa, Dr. Michael Cohen and Dr. Franz Jones. The South Florida Institute of Sports Medicine in Weston is located at 1600 Town Center Blvd., Suite C, (954) 389-5900 and in Pembroke Pines at 17842 NW 2nd Street,
    (954) 430-9901. The practice website is