Abstract
Background
Injuries around the foot and ankle are challenging. There is a paucity of literature, outside that of specialist orthopedic journals, that focuses on this subject in the pediatric population.
Data sources
In this review, we outline pediatric foot and ankle fractures in an anatomically oriented manner from the current literature. Our aim is to aid the emergency department doctor to manage these challenging injuries more effectively in the acute setting.
Results
These injuries require a detailed history and examination to aid the diagnosis. Often, plain radiographs are sufficient, but more complex injuries require the use of magnetic resonance imaging. Treatment is dependent on the proximity to skeletal maturity and the degree of displacement of fracture. Children have a marked ability to remodel after fractures and therefore mainstay treatment is immobilization by a cast or splint. Operative fixation, although uncommon in this population, may be necessary with adolescents, certain unstable injuries or in cases with displaced articular surface. In the setting of severe foot trauma, skin compromise and compartment syndrome of the foot must be excluded.
Conclusion
The integrity of the physis, articular surface and soft tissues are all equally important in treating these injuries.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
O’Toole P, Butt A, Orakzai S, McIntyre A, Callender O, Kingston R, et al. Epidemiology of sporting and recreational injuries in a paediatric orthopaedic outpatients department. Ir Med J 2008;101:173–174.
Goff I, Rowan A, Bateman BJ, Foster HE. Poor sensitivity of musculoskeletal history in children. Arch Dis Child 2012;97:644–646.
Hoppenfeld S. Ankle and foot. In: Hoppenfeld S, eds. Physical examination of the spine and extremities, 1st ed. Norwalk, Connecticut: Prentice Hall, 1976: 197–237.
Gatt A, Chockalingam N, Falzon O. Sagittal plane kinematics of passive dorsiflexion of the foot in adolescent athletes. J Am Podiatr Med Assoc 2013;103:394–399.
Englanoff G, Anglin D, Hutson HR. Lisfranc fracture-dislocation: a frequently missed diagnosis in the emergency department. Ann Emerg Med 1995;26:229–233.
Ribbans WJ, Natarajan R, Alavala S. Pediatric foot fractures. Clin Orthop Relat Res 2005;432:107–115.
Kleinman PK, Morris NB, Makris J, Moles RL, Kleinman PL. Yield of radiographic skeletal surveys for detection of hand, foot, and spine fractures in suspected child abuse. AJR Am J Roentgenol 2013;200:641–644.
Gustilo RB, Anderson JT. Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones: retrospective and prospective analyses. J Bone Joint Surg Am 1976;58:453–458.
Dodd A, Le I. Foot compartment syndrome: diagnosis and management. J Am Acad Orthop Surg 2013;21:657–664.
Plint AC, Bulloch B, Osmond MH, Stiell I, Dunlap H, Reed M, et al. Validation of the Ottawa Ankle Rules in children with ankle injuries. Acad Emerg Med 1999;6:1005–1009.
Harty MP. Imaging of pediatric foot disorders. Radiol Clin North Am 2001;39:733–748.
Shabshin N, Schweitzer ME, Morrison WB, Carrino JA, Keller MS, Grissom LE. High-signal T2 changes of the bone marrow of the foot and ankle in children: red marrow or traumatic changes? Pediatr Radiol 2006;36:670–676.
Wojtys EM. Sports injuries in the immature athlete. Orthop Clin North Am 1987;18:689–708.
Pontell D, Hallivis R, Dollard MD. Sports injuries in the pediatric and adolescent foot and ankle: common overuse and acute presentations. Clin Podiatr Med Surg 2006;23:209–231.
Salter RB, Harris WR. Injuries involving the epiphyseal plate. J Bone Joint Surg Am 1963;45:587–622.
Chambers HG. Ankle and foot disorders in skeletally immature athletes. Orthop Clin North Am 2003;34:445–459.
Sankar WN, Chen J, Kay RM, Skaggs DL. Incidence of occult fracture in children with acute ankle injuries. J Pediatr Orthop 2008;28:500–501.
Pizzutillo PD, Chandler JB, Maxwell T. Pediatric orthopedics: fractures of the growth plate. In: Griffin L, eds. Essentials of musculoskeletal care, 3rd ed. Rosemont (IL): American Academy of Orthopedic Surgeons, 2005:865–867.
Lawson JP, Keller MS, Rattner Z. Recent advances in pediatric musculoskeletal imaging. Radiol Clin North Am 1994;32:353–375.
Ertl JP, Barrack RL, Alexander AH, VanBuecken K. Triplane fracture of the distal tibial epiphysis. Long-term follow-up. J Bone Joint Surg Am 1988;70:967–976.
Horn BD, Crisci K, Krug M, Pizzutillo PD, MacEwen GD. Radiologic evaluation of juvenile tillaux fractures of the distal tibia. J Pediatr Orthop 2001;21:162–164.
Schlesinger I, Wedge JH. Percutaneous reduction and fixation of displaced juvenile tillaux fractures: a new surgical technique. J Pediatr Orthop 1993;13:389–391.
Kaya A, Altay T, Ozturk H, Karapinar L. Open reduction and internal fixation in displaced juvenile tillaux fractures. Injury 2007;38:201–205.
Jones MH, Amendola AS. Acute treatment of inversion ankle sprains: immobilization versus functional treatment. Clin Orthop Relat Res 2007;455:169–172.
Pommering TL, Kluchurosky L, Hall SL. Ankle and foot injuries in pediatric and adult athletes. Prim Care 2005;32:133–161.
Johnson GF. Pediatric Lisfranc injury: “bunk bed” fracture. AJR Am J Roentgenol 1981;137:1041–1044.
Sherief TI, Mucci B, Greiss M. Lisfranc injury: how frequently does it get missed? and how can we improve? Injury 2007;38:856–860.
Philbin T, Rosenberg G, Sferra JJ. Complications of missed or untreated lisfranc injuries. Foot Ankle Clin 2003;8:61–71.
Singer G, Cichocki M, Schalamon J, Eberl R, Höllwarth ME. A study of metatarsal fractures in children. J Bone Joint Surg Am 2008;90:772–776.
