What are Pediatric Fractures of the Foot & Ankle?

A pediatric fracture of the foot and ankle is defined as a break in the bones of the foot and ankle in children.

The foot and ankle comprise a complex joint involved in movement that provides stability and balance to the body. Together, the foot and ankle consist of 26 bones, 33 joints, and various muscles, tendons, and ligaments. Anatomically the foot is divided into the forefoot, mid foot and hindfoot. The forefoot comprises 5 toes, the midfoot includes 5 bones that form the arch of the foot, and the hind foot forms the heel and ankle. The ankle is a large joint made up of 3 bones: the tibia, fibula and talus. Ligaments and tendons run along the surface of the foot, promoting easy and flexible movement. Any significant trauma or injury to any of these structures can result in a crack or break in the foot or ankle bones. Fractures in the foot and ankle area constitute greater than 10% of all pediatric fractures.

Causes of Pediatric Fractures of the Foot and Ankle

Pediatric foot and ankle fractures typically occur when a child’s foot or lower leg twists unexpectedly while at play. during sports activities, or from a significant trauma. Fractures occur more commonly in boys. Many fractures result from sports such as basketball, soccer, inline skating, riding motorized scooters, or from a heavy object falling on the foot or ankle, or a fall from a height.

Types of Pediatric Fractures of the Foot and Ankle

Some of the common types of foot and ankle fractures include:

• Displaced Fracture: The broken pieces of the bones have separated and are out of alignment.
• Comminuted Fracture: A severe type of fracture where the bone breaks into 3 or more pieces.
• Stress Fracture: Also called a hairline fracture, this fracture appears as small thin cracks in the bone and occurs due to overuse or wear and tear.
• Non-Displaced Fracture: A fracture in which the broken bones are properly aligned and do not move out of place while healing.
• Open Fracture: A fracture in which the bone breaks through the skin, damaging the overlying skin and soft tissues and exposing the fracture site.

Signs and Symptoms of Pediatric Fractures of the Foot and Ankle

Some of the signs and symptoms of pediatric fractures of the foot and ankle include:

• Throbbing pain
• A deformity of the bone in the foot and/or ankle
• Difficulty bearing weight
• Difficulty walking
• Bruising
• Inflammation, tenderness, and redness
• Increased pain during activity and decreased pain during rest

Diagnosis of Pediatric Fractures of the Foot and Ankle

To diagnose foot and ankle fractures of your child, your physician will conduct a physical examination and may order diagnostic tests such as:

• X-rays, which provide clear image of the bone
• Computed tomography (CT) scans, which provide a cross-sectional image of the foot and ankle bones
• Magnetic resonance imaging (MRI), which provides high-resolution images of both bones and soft tissues that are not visible in an X-ray or CT scan

Treatment for Pediatric Fractures of the Foot and Ankle

Treatment depends on the type of injury. Your doctor will initially prescribe medication to relieve pain and inflammation, and suggest R.I.C.E. (rest, ice, compression, and elevation of the injured leg above heart level), which may relieve symptoms in mild strains and sprains. Some major injuries may require bracing, or the use of a cast or boot to avoid weight-bearing, and to promote healing.

Severe injuries may require surgery to reduce fractured bones, or repair or reconstruct torn ligaments and tendons.

Procedure

There are many surgical techniques to treat foot and ankle trauma. Some of them include:

Open reduction and internal fixation This surgical procedure for foot fractures involves an incision made to expose the fracture. The fragments of bone are realigned and stabilized with metal wires, screws, pins, and plates. The incision is closed and dressed. The foot is placed in a splint, shoe, boot or cast.

Percutaneous screw fixation For some types of fractures, reduction can be achieved with a closed manipulation of the foot using X-ray. The bone can either be pushed or pulled to set it in place without making a large incision. This method, called percutaneous fracture fixation, can be performed with one or more small incisions instead of the traditional large incision, through which the implants are fixed.

Arthroscopy This is a minimally invasive surgery where a small camera called an arthroscope is used to view the ankle joint and guide miniature instruments to remove fragments of torn ligament, bone or cartilage from within the joint.

Reconstruction Torn ligaments can be surgically repaired with sutures or replaced with a graft, which can be another ligament and/or a tendon retrieved from the foot or around the ankle.

Fusion In cases of severe injury, damaged bones are fused together so that they heal into one single bone. This limits movement in the joint.

Post-operative Care

Following surgery, your foot or ankle will be immobilized using a splint or cast. You will be advised a course of physical therapy to regain range of motion and to promote flexibility and strength in the foot.

Fractures are monitored for healing with X-rays. You will be informed when it is safe to return to sports and regular activities.