Sports Injuries in the Immature Athlete

By: Robert H. Sheinberg, D.P.M., D.A.B.P.S., F.A.C.F.A.S.

The immature athlete has open growth plates(areas on the bone that allow it to grow). These areas are weaker than the surrounding bones and ligaments making them susceptible to injuries.

Injuries may be acute or secondary to overuse. Acute injuries occur instantaneously as in fractures or tendon ruptures. Overuse injuries occur from repetitive stress to an area that may not be accustomed to the activity. Stress fractures and tendonitis are overuse injuries.

General treatment phases:

  1. Immediate assessment and treatment: Identifying the injured body part is crucial. Reducing the inflammation with rest, ice, compression, and elevation diminish the magnitude of the injury. Crutches and cast immobilization may be necessary to allow the area to heal.
  2. Regaining joint motion: when the acute phase of the injury has subsided, gentle exercises to improve joint motion is necessary.
  3. Strengthening: Once motion is restored, gradual muscle strengthening and coordination programs allow a return to sports.

Acute Fractures (Broken Bones): These occur when the bone or growth plate have been disrupted. They usually occur acutely from a fall but may also occur from a twisting motion. The bone will be tender and surrounding areas swollen. Treatment may include immobilization with a cast and crutches. Surgery may be necessary if the bones are out of place.

Stress Fractures: These injuries occur when an abnormal amount of stress is applied to the bone over a short period of time. They are common when an athlete increases training intensity too quickly. Pain occurs later on in an activity. Pinpoint tenderness on the bone and swelling are seen. Rest and occasionally immobilization in a brace or cast may be necessary to allow healing. Cross training during the healing process is important.

Shin Splints: A term used to describe pain on the front or inside of the shin bone (tibia). The muscle attached to the bone pulls on it causing the area to become inflamed. These are common in athletes with poor flexibility, inadequate shoe gear and flat feet. Pain occurs during the activity and is diffuse along the shin bone (not pinpoint as in stress fractures). Treatment is directed to the cause. Change in the training activity, shoe gear, flexibility and strength training as well as custom molded orthotics for the shoes may eliminate the problem and prevent recurrences.

Heel Pain: The growth plate on the back of the heel is susceptible to repetitive stress from the Achilles tendon and arch ligament. Most common between ages 8-14. Tenderness without swelling is present on the back and sides of the heel. Pain is more common at the end of an activity or after sitting and then getting up to walk once the activity is over. Poor flexibility, flat feet, growth spurts may contribute to this problem. Proper Shoe Gear, heel lifts, stretching the Achilles tendon and custom molded orthotics for shoes may be necessary. Walking in bare feet is to be discouraged. Occasionally night splinting to stretch the tight muscles in the back of the leg will allow complete healing.

Foot and Ankle Sprains: These injuries occur when the foot or ankle twists stretching or tearing the ligaments. They are less common in the immature athlete. Pinpoint swelling and tenderness is present over the ligament. Mild injuries may require rest, ice and an ankle brace. Moderate to severe injuries require immobilization in a cast or boot to allow the ligaments to heal, thus preventing chronic instability. 

Turf Toe: This condition occurs with hyperextension of the big toe causing injury to the growth plate, joints, tendons, ligament or sesamoids (small bones within tendons that help bend the big toe). These injuries cause significant swelling on the ball or top of the foot in the big toe area and difficulty weight-bearing. Immediate assessment is necessary. Crutches and immobilization are usually required to allow healing.

We are able to make an immediate impact on a child’s or teenager’s life by identifying the injury and formulating a treatment plan. We believe their health, self-esteem, and ability to interact with their peers may be adversely affected by a painful condition if untreated. Through a combination of physical therapy, proper conditioning, proper shoe gear education and custom molded orthotics we can help restore their ability to participate in activities.