Children’s Foot and Ankle Fractures

For children, especially those involved in sports, foot and ankle injuries are common.  In fact, five percent of all pediatric fractures are localized to the foot. In the foot, the most commonly fractured bones are the metatarsals.  The metatarsal bones are the longest bones in the foot and are located before the toe bones. Younger children have very flexible bones, so they are less likely to have a fracture; however, they are not exempt from sprains or contusions.  A contusion is a deep soft tissue injury.  Patients who have suffered sprains/contusions and fractures relate that the sprain or contusion may have been as or even more painful than a fracture.

Often times, children that are very involved in sports or young children who may have suffered an injury while misbehaving may not want to tell their parents that they are having pain. It is important to seek medical attention immediately if they are unable to bear weight, have significant swelling, bruising, and/or pain.

Radiographs will be taken to assess for any broken bones or other abnormalities.  If a complex fracture is noted on radiographs, more advanced imaging may be indicated, such as a CT scan or MRI.

The most devastating fracture pattern seen in a child can be one that crushes a growth plate, which means that the bone may not finish growing properly.  This type of injury is usually seen after jumping or falling from a high point. There is usually surgical intervention needed for these patients; however, it may not be done until they are skeletally mature.

Anytime, a bone is broken, patients are at risk of the bone not healing and progressing to a non-union. The risk of non-unions is higher in those that smoke cigarettes or continuously walk on their fractured foot. However, the risk of nonunion in the pediatric population is much less than adults. Other sequelae of a broken bones is developing arthritis, stunting growth of that bone, deformity, abnormal gait, and/or pain.

As mentioned previously, children’s bones are very flexible so it will usually take a
significant amount of force to actually cause a fracture. Luckily, for children they possess different bone and healing characteristics than adults, which makes
them more amenable to conservative treatment, as well as faster healing times.

For most pediatric fractures, even fractures that have been displaced, meaning the broken bone fragments are not perfectly aligned, will heal and re-straighten into anatomical alignment with 3-6 weeks in a non-weightbearing cast.  In adults, this is not true; if a fracture is mal-aligned it will not heal properly without surgery.

Some general tips if your child ever has any injury, remember the acronym RICE for after the injury. RICE stands for Rest (stop activity), Ice (ice 20 minutes on and 20 minutes off), Compression (use an ACE bandage to provide lite compression, if available), and Elevate the foot (use several pillows to get the foot above the level of the heart). RICE will help prevent swelling, which will ultimately help decrease pain. Also, never give your child Aspirin as it can cause Reye’s syndrome, which is characterized by sudden brain and liver damage. Children’s Tylenol is safe to help control pain if need, but it is best to seek medical attention immediately.

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