Calcaneus In Children Research Articles

Calcaneus fracture in the child.

We reviewed 80 fractures of the calcaneus in 78 children through a 30-year period. The fractures were more equally distributed between the sexes than in adults. In contrast to adults, intraarticular fractures of the calcaneus in children constitute less than half, probably because a lower proportion of children sustain the fracture as a result of a fall. Associated injuries were mainly encountered by children who were traffic accident victims. It is disputable that the calcaneus in children is more resistant to fracture than in adults. The rarity of the fracture in children is more likely the result of less exposure to trauma leading to calcaneal fractures and also that the fracture is often overlooked.

Hemitransplantation of the tendo calcaneus in children with spinal neurological disorders.

In paralytic lesions in which the triceps surae is the only active muscle in the leg, elongation or division of the tendo calcaneus alone may not be enough to prevent recurrence of equinus deformity. In 10 patients (13 limbs) with this pattern of muscle activity, equinus deformity was treated by hemitransplantation of the tendo calcaneus. At follow-up, which was beyond the end of growth in seven limbs, there was no recurrence of deformity in nine. In three of the four failures, a technical fault may have caused loss of activity in the transplanted part of the tendon. The two-stage operation described is recommended in the management of this pattern of paralytic deformity.

Effect of weight-bearing on the appearance and development of the secondary calcaneal epiphysis.

The calcaneus ossifies from a primary center for the main body of the bone and from a secondary center for the posterior extremity (4). The secondary center has received considerable medical attention because in normal children it is strikingly dense when compared to the calcaneal body and it shows considerable irregularity of ossification (Fig. 1). Sever (11) related this roentgen appearance with pain and tenderness in the heel and termed it apophysitis of the os calcis. “Sever's disease” became and remained a popular diagnosis (1, 3, 7–9) until 1948 when Hughes (6) concluded that the changes termed Sever's disease were normal and “there is insufficient proof that osteochondrosis is ever the underlying cause of adolescent painful heels.” Caffey (2) re-emphasized mistaking the normality of the roentgen findings for apophysitis, and the condition is receiving less and less attention. Albeit the sclerosis of the calcaneal secondary epiphysis has been recognized as normal, no explanation has been given for the increased density. A preliminary observation that the sclerosis and development of the epiphysis might be related to weight-bearing prompted a roentgenological study of the calcaneus in children with and without normal weight-bearing. The purposes of the study are to determine if the secondary epiphysis is sclerotic in all normal weight-bearing children and to evaluate the relationship of weight-bearing to the sclerosis and developmental ossification of the epiphysis. Material and Method Calcaneal roentgenograms of 289 children were studied: 130 boys and 159 girls, aged four to seventeen years. One hundred and three were examined primarily for this study; the remaining 186 were patients referred to the Department of Radiology for recent trauma to the lower leg, ankle, or foot, but not primarily to the calcaneus. No child had symptoms referable to the calcaneus. Studies were also made of an additional 74 children who did not have normal weight-bearing either unilaterally or bilaterally. Forty-two were boys; 32, girls, with an age distribution ranging from seven to fifteen years. The cause of the non-weight-bearing was neurological in 15 boys and 24 girls and fracture in 27 boys and 8 girls. In the neurogenic disease group were 20 patients with poliomyehtis, 12 with spinal meningocele, and 7 with cerebral palsy. All fractures were of the lower tibial shaft, tibial malleoli, or metatarsals. Each calcaneus was evaluated in respect to (a) the presence of sclerosis of the secondary epiphysis and (b) the appearance and development of the epiphyseal ossification. Presence of Sclerosis The calcaneal epiphysis is not sclerotic when ossification commences in it. Ossification begins in several irregular foci which fuse together within a few months after their appearance. All patients with normal weight-bearing in this study showed sclerosis of the epiphysis by the time the foci fused.