Management of foot and ankle injuries in pediatric and adolescent athletes: a narrative review

Abstract

In this review, we focus on the treatment of injuries to the foot and ankle in the adolescent athlete. While many injuries in the adolescent foot and ankle are similar to or overlap with their counterparts in the adult population, the anatomy of the adolescent ankle, especially the presence of growth plates, results in different injury patterns in many cases and calls for specific management approaches. We discuss the unique anatomy of the pediatric patient as well as the diagnostic evaluation and treatment of common injuries in the young athlete.

Keywords: Lisfranc injury; ankle; foot; growth plate; lower extremity; pediatric athlete.

Figure 1

Lateral view of the ankle, with arrow indicating the os trigonum.

Figure 2

(A) Anteroposterior and (B) mortise views of the ankle demonstrating a posteromedial osteochondral lesion of the talus (arrows); (C,D) magnetic resonance imaging of the lesion showing edema of the underlying talus and fluid beneath the fragment; (E) intraoperative picture of unstable osteochondral lesion; (F) following curettage and microfracture.

Figure 3

(A) Anteroposterior radiographs of bilateral feet demonstrating widening of the first to second intermetatarsal space, with a positive “fleck sign” representing an avulsion fragment of the ligament from the medial cuneiform. (B) Anteroposterior, (C) oblique, and (D) lateral views of the foot postoperatively, showing reduction and fixation with partially threaded cannulated screws. The patient also had minimally displaced fractures of the second and third metatarsals that were treated non-operatively.

Figure 4

(A) Tuberosity avulsion fractures in zone 1; (B) a Jones fracture in zone 2; (C) apophysis of fifth metatarsal, often confused with fracture; (D) clockwise from top left: placement of a guidewire and then a cannulated partially threaded screw for fixation of the Jones fracture.

Figure 5

(A) C-sign of talocalcaneal coalition (arrow); (B) coronal computed tomography demonstrating bony coalition.

Figure 6

(A) Elongation of the anterior process of the calcaneus (anteater sign, arrow); (B) oblique foot films showing calcaneonavicular coalition (arrow); (C) after resection of the coalition.

Figure 7

A 16-year-old male sustained an injury playing football. (A) The initial ankle mortise appears normal; (B) however, external rotation stress films demonstrate widening of the mortise and medial clear space with talar shift; (C) after syndesmotic fixation with tightrope construct.

Figure 8

(A–C) Triplane ankle fracture variant with Salter–Harris type IV component (magnetic resonance imaging); (D,E) postoperative fixation with cannulated screws parallel to the physis (D, anteroposterior; E, lateral).

Figure 9

(A) Posterior and (B) lateral Tillaux ankle fracture (arrows); with (C) posterior and (D) transphyseal fixation, in a nearly skeletally mature female.