Traction apophysitis

Better Health Channel, 2021Royal Childrens Hospital

Traction apophysitis describes an overuse injury to cartilage and the bony attachment of tendons (apophysis) that is usually seen in children older than 10 years and adolescents. The onset of symptoms is gradual. Apophyses of the upper and lower limbs can be affected. Some of the more common sites of injury include:

• calcaneus (Sever disease)—affects children between the ages of 8 and 14 years, usually around puberty and is slightly more common in boys
• tibial tuberosity (Osgood-Schlatter disease)—is the most common cause of knee pain in children aged 10 to 15 years, and is more common in boys and active children.

Pain associated with traction apophysitis is usually exacerbated by activity and resolves with skeletal maturity.

Blood investigations or imaging are not required to confirm the diagnosis but X-rays may be used to exclude differential diagnoses such as fracture.

Discuss management strategies with patients and caregivers. Modification of activities that cause pain to flare may be required; however, continued activity is not associated with harm. After a flare, physical activity and loads on affected limbs may need to be temporarily reduced. If pain relief is required, use the drug regimens in Oral drugs for mild, acute nociceptive pain in children.