Trauma or Overuse

1. Fracture. Often, there will be an obvious extremity deformity. However, so-called toddler fracture (a nondisplaced, spiral fracture of the distal tibia) frequently presents without objective findings suggestive of a fracture.

2. Soft tissue injuries. These include ligamentous sprains, muscle strains, tendonitis, and contusions. A severe sprain may be associated with joint laxity.

3. Osgood-Schlatter disease. Especially in boys 11-15 years of age. Causes microavulsions of proximal tibia, at the point of patellar tendon insertion. Often bilateral.

4. SCFE. Especially in obese boys, in early adolescence. Capital femoral epiphysis slips posterior and inferior to the proximal femoral metaphysis. Frequently bilateral. Diagnosis is often made after trivial injury.

5. LCPD. Especially in boys 4-9 years of age. Produces aseptic necrosis of the femoral head; cause is unknown.

6. Osteochondritis dissecans. Especially in boys 11-15 years of age, possibly from repeat trauma or overuse. Separation of a small portion of the distal end of a long bone (eg, femur or tibia) causes knee or ankle pain.

7. Chondromalacia patellae. Common in early adolescence. Produces fissures and erosions of articular cartilage of the patella. Probably caused by overuse.

8. Foreign body. For example, glass or a splinter. Consider when child has localized swelling or tenderness on plantar surface of foot. Other painful conditions in this area that may cause pain include a plantar wart or a blister such as might result from poor-fitting shoes.

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