Treating the Adolescent Patient?
An article came to my attention some months ago which immediately piqued my interest. It was entitled “Overuse injuries in the Adolescent”. There is a huge amount of publicity these days on how our children are becoming more obese and how it is a growing epidemic. There is increasing pressure on parents to encourage and enforce healthy eating and increased activity in our children to prevent this growing problem. I am not for one second suggesting that this is not a problem and certainly it is an epidemic that needs to be dealt with, but what happens however if our once active children become injured and start to lose interest in sport due to pain and injury? Where do we go? What should we do and when should we seek help?
In my day to day practice in treating lower limb pathology I am certainly not seeing the inactive obese child, I’m seeing the other end of the spectrum and as a clinician I am treating more overuse injuries as a result of the increasing participation of children in sport. Many of the children we see play multiple sports after school in addition to the regular activity that they partake in at school. Podiatry and physiotherapy are key to resolving these injuries as the knee; foot and ankle are some of the commonest locations for growth plate or overuse injuries in the adolescent patient.
Some of the common injuries that we see are:
Osgood Schlatters Disease: Pain at the bump just below the patellar. This is a common overuse injury at the growth plate
Sinding-Larson-Johansson Disease: Again an overuse injury resulting in pain at the lower pole of the patellar
Anterior Knee Pain: Often dismissed as growing pains, this can be a combination of overuse, muscle imbalance, poor flexibility (which will increase as the child goes through growth spurts), poor alignment
Severs Disease: presents as heel pain and is due to the stresses of the Achilles pulling on the posterior aspect of the heel and again can be exacerbated by poor flexibility.
In a recent study carried out by Feit and Kashanian the biomechanics of the foot and ankle were observed and documented and they concluded that adverse biomechanics predispose many of these patients to overuse and growth plate injuries. When examining the child they placed them into one of three categories mild, moderate or severe eversion of the heel bone, which in lay terms can equate to degree of over pronation or how flat the child’s feet were. From this they concluded that anyone who had more than mild eversion/flat foot would benefit from orthtoses in treating the injury, it was also an essential part of preventing the recurrence of the injury in the growing adolescent foot. As a parent it is clearly a challenge to assess how flat footed your child is, especially when this will change with static and dynamic activity but what is important to know is when your child has a problem there are treatments available and the injury may not always be growing pains.
If your child sustains an injury it is important for the clinician to understand the biomechanics of the foot and ankle in order to treat. The aim of the treatment should be to reduce the ground reaction forces and resulting stress on the bones, joints and soft tissues of the foot and ankle. Once the mechanics are understood the most appropriate treatment plan can be implemented. Whether that should be good and supportive footwear, moderation of activity, orthtoses, strengthenng and conditioning under the supervision of a physiotherapist or more often than not a combination of these interventions. The aim of the treatment should not only be resolution of the symptoms but preventing a recurrence of pain. Clearly this is a challenge but the more awareness we have about these types of injuries and the types of treatments that have proven successful; the more chance we have of keeping our adolescents pain free and active.
BSc (hons) Podiatry, SRCh, HPC registered
Amanda Walker was asked to write a piece for Adolescent Patients to be included in a publication for a local physio practice which we would like to share with you.