Fractures

Feet can be a common site for injuries, especially in young children. These injuries usually happen when a large, heavy object falls directly onto the foot. While it's often the toes that are affected, fractures can occur in any bone of the foot. While breaks in the toes can be treated with a brief period of immobilization, the most traumatic fractures, which affect the heel bone or talus bone, require surgery for the best outcome.

Metatarsal fractures

There are five metatarsals in the foot; the first metatarsal is in line with the big toe and the fifth is in line with the little pinky toe. The second and fifth metatarsals are firmly attached together, protecting the bones from separating too far from each other if one is broken. Since our feet have this built-in protection, metatarsal fractures don’t usually require surgery. Treatment typically consists of either a boot or cast for three to eight weeks. The longevity and type of mobilization will depend upon the age of your child, as well as the location and severity of the injury.

Types of fifth metatarsal fractures

Styloid avulsion fractures

This includes a fracture to the part of the bone closest to the middle of the foot, usually caused by a sudden "rolling" of the ankle and foot. There can be painful swelling and bruising on the outside of the foot and it may also be difficult to bear weight on the foot. X-rays of the injured foot show a horizontal line (transverse fracture) across the end of the metatarsal closest to the middle of the foot.

Jones fracture (metaphyseal-diaphyseal junction fracture)

The Jones fracture is a special fracture that occurs at the base of the fifth metatarsal. It involves the fifth metatarsal as well as the joint between the fourth and fifth metatarsal. This fracture is caused by a sudden force under the outside foot, such as landing from a high jump onto another player’s foot. X-rays show a horizontal line (transverse fracture) through the end of the metatarsal closest to the middle of the foot. The line also extends into the joint between the bases of the fourth and fifth metatarsal.

This injury causes pain and swelling on the outside of the foot, and putting weight on the foot is difficult due to pain. When a fracture occurs in this area, it’s less likely to heal due to the poor blood supply in the area. Some of these fractures may have a better outcome with surgery.

Treatment for fifth metatarsal fractures

Treatment for a styloid avulsion fracture includes having your child:

  • Ice their ankle
  • Elevate their ankle
  • Wear a firm-soled shoe, walker boot or cast
  • Use crutches if walking is painful

If the bone fragment is displaced, surgery may be needed. In most styloid fractures, your child can return to their activities when they’re able to use the injured foot without pain. Pain usually resolves after about four weeks.

Treatment for a Jones fracture also includes icing, elevation and rest. A cast is usually worn for at least six to eight weeks. If your child’s fracture doesn’t heal with casting, surgery may be required.

Phalangeal (toe) fractures

Two phalanges make up the big toe. Three phalanges make up the lesser toes (toes two to five), which means they are even more susceptible to fracture. In general, if your child has injured a toe and it looks straight, then no surgical treatment is needed—it can often be buddy taped to the adjacent toe for two to three weeks. If the toe looks crooked, then your child may benefit from having it set and then pinned surgically to prevent the toe from becoming crooked again.

In a situation where a fracture happens beneath an injured nail (Seymour’s fracture), nail tissue can be stuck in the fracture and will need to be removed to allow the toe to grow properly.

In children, there’s an area on the heel bone where the bone grows. This is called the growth plate, or apophysis. Calcaneal apophysitis, also called Sever’s disease is the most common cause of heel pain in children, adolescents and teenagers.

Sever's Disease

In children, there’s an area on the heel bone where the bone grows. This is called the growth plate, or apophysis. Calcaneal apophysitis, also called Sever’s disease is the most common cause of heel pain in children, adolescents and teenagers.

Sever's Disease Causes

Calcaneal apophysitis, or Sever's disease, happens when the heel growth plate inflames from overusing the foot with repetitive heel strikes. Heel pain in kids can be caused by:

  • Overuse playing sports
  • Wearing shoes with poor heel padding our poor arch supports
  • Running and jumping, worsening the symptoms

Sever's Disease Diagnosis

A physical examination will include checking for tenderness over the bottom part of your child’s heel. We may order an X-ray to be sure there is no damage to the growth plate.

How do you treat Sever's Disease?

It’s very important your child wear shoes with padded heel surfaces and good arch supports on an ongoing basis. Your healthcare provider may recommend shoe inserts, called orthotics. You can buy orthotics at a pharmacy or athletic shoe store, or have them custom-made.

If pain persists, your child may need to rest or stop activities that cause heel pain, and may be prescribed an anti-inflammatory medicine.

When can my child return to their sport or activity?

The goal of Sever's Disease treatment is to return your child to his or her sport or activity as soon as is safely possible. If your child returns too soon, the injury may be made worse and lead to permanent damage. Everyone recovers from injury at a different rate. Your child’s return to their activities will be determined by how soon your child’s heel recovers, not by how many days or weeks it has been since the injury happened. In general, the longer your child has symptoms before starting treatment, the longer it will take to get better.

If the heel hurts, your child needs to rest from their sport or activity. Your child should rest for several days at a time and then go back gradually. Before returning, your child should be able to jog, then sprint painlessly, and be able to hop on the injured foot painlessly. If at any time during this process your child develops further heel pain, they should rest for three to four more days until the pain is gone before trying to return again.

How can calcaneal apophysitis be prevented?

Calcaneal apophysitis is best prevented by having your child wear shoes that fit properly. The heel portion of the shoe should not be too tight, and there should be good padding in the heel.

Some children simply get too much physical activity (such as playing on too many teams, practicing for hours, etc.). Heel pain may be a message from your child’s body, asking them to slow down. If your child is experiencing heel pain, we’re here to help.