Physeal stress injury and osteochondrosis in the ankle and foot of young athletes

BACKGROUND: Epiphyseal physeal stress injuries (PSIs) and osteochondroses of the foot and ankle in pediatric athletes can result in prolonged absence from activities, surgical intervention or growth arrest, and/or alignment deformities. SOURCES OF DATA: A systematic review was performed using PRISMA guidelines. Medline, EMBASE and CINAHL electronic databases were searched to identify articles. Clinical studies evaluating the diagnosis and outcomes of PSIs and osteochondrosis of the foot and ankle in pediatric athletes were included. AREAS OF AGREEMENT: PSIs and osteochondrosis of the foot and ankle require imaging diagnosis often involve the use of radiographs and/or MRI. Conservative treatment is often the initial approach to managing these injuries. These injuries can result in prolonged absence from activity. AREAS OF CONTROVERSY: For injuries that do not resolve with conservative treatment, surgery is often the next step. The timing and type of procedure is variable. GROWING POINTS: Early findings of PSIs or osteochondroses of the foot and ankle may be subtle or inconspicuous on initial radiographs and may require additional imaging workup to ensure appropriate diagnosis. Delayed diagnosis may result in prolonged symptoms and absence from activity and possibly result in growth disturbances. AREAS TIMELY FOR DEVELOPING RESEARCH: Injury surveillance in all youth sports and activities must include screening for PSIs and osteochondroses to ensure better documentation of incidence among youth. Well-planned prospective longitudinal epidemiological and imaging studies are required to provide more accurate data on the occurrence and natural history of these injuries.