Postnatal Growth of the Calcaneus Does not Simulate Growth of the Foot

ArticleinJournal of pediatric orthopedics 32(1):93-9 · January 2012with4 Reads
Impact Factor: 1.47 · DOI: 10.1097/BPO.0b013e31823c9038 · Source: PubMed

In the absence of age and sex-specific normative data for postnatal growth of the calcaneus, it has been hypothesized that the growth of the calcaneus would simulate growth of the foot. A total of 860 normal lateral foot radiographs, 50 (25 female and 25 male) for each year of development from 1 to 18 years, and 10 radiographs from birth till 1 year, were measured for the length and height of the calcaneus, Bohler angle, the appearance, fusion and fragmentation of calcaneus apophysis, and the height and width of apophysis. Nonlinear curves were fit to a growth chart of the calcaneus, and the results were superimposed on the historical growth charts of the foot, stature, and long bones (femur, tibia). The ratio of calcaneus length to apophysis height was calculated. Growth of the calcaneus does not simulate growth of the foot (which attains 50% of its mature dimension by the age of 1 y in girls and 1.5 y in boys), but simulates the growth of the long bones, which attain 50% of their mature length after the age of 3 years in girls and 4 years in boys. Bohler angle remains within normal limits across all ages. When the length of calcaneus is triple the height of its apophysis, 80% of calcaneus growth is complete. We provide normative data for postnatal growth of the calcaneus. On the basis of these data, the assumption that growth disturbance in children affects the length of the calcaneus proportionately less than similar disturbances in the long bones, is false. Children <3 years have at least 50% of growth remaining. Bohler angle should be maintained at all ages. This study of postnatal growth of the calcaneus provides age and sex-based normative data to predict growth pattern of calcaneus.

    • "Erst in jüngerer Zeit sind Arbeiten erschienen , die sich mit der Wachstumsdynamik der Fersenbeinapophyse beschäftigen . Sie zeigen auf, dass der Calcaneus ähnlich in die Länge wächst, wie dies an langen Röhrenknochen zu beobachten ist [21], und ähnlich in Stadien verknöchert wie der Beckenkamm ([19] "
    [Show abstract] [Hide abstract] ABSTRACT: Background The structure of apophyses and apophyseal growth plates is not substantially different from those of epiphyses and epiphyseal growth plates. In contrast to epiphyseal growth plates, apophyses and apophyseal growth plates do not contribute to the longitudinal growth of the extremity. They are associated with their adjacent joints, triggering the lengths of their lever arms and influencing their external shape and internal architecture. The formative stimulus on apophyses is given by muscles and tendons inserting at the apophysis or canopying the apophsis. Apophysis of the greater trochanter The apophysis of the greater trochanter significantly contributes to the lever arm length of the hip joint. Its growth activity triggers the neck-shaft angle and finally the centration of the hip joint. Tibial apophysis The tibial apophysis interacts with the slope of the proximal tibia and hereby influences the sagittal stability of the knee joint. A damage to the growth plate of the tibial tubercle leads to an anteverted tibial slope and a genu recurvatum difficult to treat. Calcaneal apophysis The calcaneal apophysis determines the length and position of the calcaneus and herewith influences the torque of the ankle joint. Summary In a nutshell you may regard the apophyses as adjusting screws acting on their adjacent joints and influencing their growth, form and structure.
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  • [Show abstract] [Hide abstract] ABSTRACT: Pediatric sports participation is skyrocketing and in the United States, as over 21/2 million children suffer sports-related injuries every year. Most pediatric sports injuries involve the lower extremity with foot injuries among the top ten most common reasons for pediatric hospital admissions. Sport-specific data outlines the importance of understanding these injuries. Fractures of the pediatric foot and ankle are number three on the list for soccer, the number one injury associated with martial arts, and the second most common injury in youth football. This chapter outlines points and offers illustrative cases of some of the most common orthopedic sports-related pediatric foot entities. These include: accessory navicular, Iselin disease, Jones fracture, Freiberg's infraction, Sever apophysitis, tarsal coalition. © 2014 Springer Science+Business Media New York. All rights are reserved.
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