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Pain in the Balls of a Child's Foot
Freiberg's Disease The
spontaneous development of pain in children generally indicates some
form of injury to the growth plate of a growing bone. This can occur
without a specific memorable event. When pain occurs in the ball of a
child's foot the most likely cause is injury to the growth plate of one
of the long bones behind the toes called metatarsals. The most common
bone involved is the metatarsal behind the second toe. When numbering
the toes the big toe is the first toe. This condition is called Freiberg's disease.
This disorder is most frequently seen in the adolescent between the
ages of 13 - 15 years of age. It is three times as likely to occur in
females as compared to males. The pain is a result of a loss of blood
flow to the growth plate in the bone. Diagnosis The
diagnosis of Friebergs disease is made by x-ray evaluation. X-rays will
reveal a flattening of the head of the metatarsal bone. Early changes
may be very subtle or not apparent. On physical exam there may be
swelling in the area that is tender to touch. A useful tool for
diagnosing growth plate injuries and stress fracture is to strike a
tuning fork and placing the vibrating tuning fork on the area of the
suspected site of injury. Pain with vibration may indicate bone or
growth plate injury. Treatment
Treatment consists of reducing pressure under the affected bone. This
may consist of anything from using crutches to a custom insole for the
shoe called an orthotic.
Left untreated the affected bone may not develop properly and permeate
damage to the joint behind the affect toe may result in painful
arthritis. Once the joint becomes arthritic surgery to place an
artificial joint may be required.
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