Pediatric Problems and Rehabilitation Geared to the Young Athlete

Foot and ankle problems in the young athlete differ from those in adults. These differences relate primarily to skeletal maturity, as the presence of open growth plates and secondary ossification centers and the more cartilaginous nature of pediatric bone impact the injury patterns and treatment approaches for children. Coalitions tend to present during childhood, as bones begin to ossify, and may require resection. Pes planus is normal in infancy but may cause problems in adolescence, especially if rigid. Hallux valgus is primarily managed conservatively, and surgery, if needed, is often delayed until skeletal maturity. Accessory naviculars are common in up to 20% of the population but may be excised if persistently painful. Osteochondroses such as Sever’s disease, Iselin’s disease, Kohler’s disease, and Freiberg’s disease can present in adolescent athletes; these typically resolve with conservative management. Osteochondritis dissecans (OCDs) usually occurs in the talus and requires drilling or grafting when advanced. Distal tibial fractures in an open physis pose a risk of leg length discrepancy and must be carefully evaluated; triplane and Tillaux fractures are unique fracture types found in adolescents nearing skeletal maturity. Most adolescent athletes will recover well from foot fractures and ankle sprains without surgery, but some variants require more aggressive intervention.