Foot-pain.

Area of Science:

• Pediatric Orthopedics
• Sports Medicine
• Adolescent Health

Background:

• Foot pain is a common complaint in children and adolescents.
• Pain is frequently localized to the heel, with midfoot and forefoot pain being less common.
• This review focuses on causes of foot pain presenting with a normal clinical appearance.

Purpose of the Study:

• To discuss the etiology of pediatric foot pain when the foot appears clinically normal.
• To outline the common causes, diagnostic considerations, and management strategies for such conditions.

Main Methods:

• Review of common etiologies for pediatric foot pain with a normal clinical presentation.
• Discussion of conditions including Sever's disease, Freiberg's disease, Köhler's disease, and tarsal coalition.
• Consideration of less common causes such as stress fractures, infections, and tumors.

Main Results:

• Sever's disease, linked to overuse and obesity, affects the calcaneal apophysis and typically presents with normal radiographs.
• Freiberg's disease (avascular necrosis of metatarsal heads) and Köhler's disease (navicular necrosis) are discussed, with conservative treatment.
• Tarsal coalition can lead to rigid flatfoot, and other differential diagnoses include stress fractures, infections, and tumors.

Conclusions:

• Several conditions can cause pediatric foot pain despite a normal clinical examination.
• Management often involves activity modification, supportive footwear, and weight reduction for conditions like Sever's disease.
• Conservative treatment is standard for avascular necrosis and tarsal coalition, with a broad differential diagnosis for persistent pain.