Lower Limb Osteochondrosis and Apophysitis in Young Athletes—A Comprehensive Review
Source abstract
Abstract
Osteochondrosis and apophysitis are common causes of pain in the growing skeleton, each with different causes and treatment approaches. Osteochondrosis involves degenerative processes affecting the epiphyseal ossification centers of the developing bones, while apophysitis results from repetitive traction injuries to the tendon insertions and affects both the cartilage and the underlying bone. Raising awareness of these conditions is crucial to facilitate the recovery of young athletes and prevent their sporting careers from being jeopardized early on. This review presents six known lower limb conditions that occur in young athletes, including three apophysitis such as Osgood–Schlatter disease, Sinding–Larsen–Johansson syndrome, and Sever’s disease, and three osteochondroses, including Perthes’ disease, Köhler’s disease, and Freiberg’s disease. The aim of this review is to outline the pathophysiology, clinical presentation, and treatment strategies for each of these conditions to provide a comprehensive understanding of their impact on young athletes. This review will provide clinicians, coaches, and physiotherapists with essential, evidence-based insights to increase their awareness of these conditions and refine treatment strategies for young athletes.
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Research context
OpenAlex topics: Bone fractures and treatments · Genetics and Physical Performance
SciVX discovery tags are terminology-based. OpenAlex topics are source-provided classifications.
Affiliations
Interdisciplinary Scientific Group of Sports Medicine, Department of Sports Medicine, Medical University of Lublin, 20-093 Lublin, Poland
Department of Pediatric Radiology, Medical University of Lublin, 20-093 Lublin, Poland
Department of Sports Medicine, Medical University of Lublin, 20-093 Lublin, Poland
References (100+)
Show source-provided references
1. Bone Health in Young Athletes: A Narrative Review of the Recent Literature10.1007/s11914-023-00796-5 ↗
2. Apophysitis and Osteochondrosis: Common Causes of Pain in Growing Bones
3. Clinical sports medicine, 3rd edn10.1136/bjsm.2006.030312 ↗
4. Sex-dependent differences in single-leg squat kinematics and their relationship to squat depth in physically active individuals10.1038/s41598-020-76674-2 ↗
5. Altered squat movement pattern in patients with chronic low back pain
6. Osteochondroses and apophyseal injuries of the foot in the young athlete10.1249/JSR.0b013e3181f19488 ↗
7. Apophyseal injuries in children’s and youth sports10.1093/bmb/ldw041 ↗
8. Assessment of Osgood-Schlatter disease and the skeletal maturation of the distal attachment of the patellar tendon in preadolescent males10.1177/2325967114542084 ↗
9. Do we really need radiographic assessment for the diagnosis of non-specific heel pain (calcaneal apophysitis) in children?10.1007/s00256-009-0774-y ↗
10. Imaging findings of lower limb apophysitis10.2214/AJR.10.5308 ↗
11. Shedding light on incidence and burden of physeal injuries in a youth elite football academy: A 4-season prospective study10.1111/sms.14059 ↗
12. Incidence of calcaneal apophysitis (Sever’s disease) and return-to-play in adolescent athletes of a German youth soccer academy: A retrospective study of 10 years10.1186/s13018-022-02979-9 ↗
13. Growth-related sports injuries among young male professional football players in the Netherlands: A prospective cohort study concerning injury incidence, severity and burden
14. Injury Incidence and Burden in 979 Player Seasons of an Elite Dutch Soccer Academy
15. A History of Eponyms in Traction Apophysitises
16. Osteochondroses10.1055/s-0038-1627094 ↗
17. Sports-related overuse injuries in children10.1016/j.otsr.2014.06.030 ↗
18. Etiology and pathogenesis of osteochondrosis10.1354/vp.44-4-429 ↗
19. Osteochondrosis: Common causes of pain in growing bones
20. Prevalence of childhood and adolescent soccer-related overuse injuries10.2152/jmi.61.369 ↗
21. Articular osteochondrosis: A comparison of naturally-occurring human and animal disease10.1016/j.joca.2013.08.011 ↗
22. Apophysitis Among Male Youth Soccer Players at an Elite Soccer Academy Over 7 Seasons10.1177/23259671211065063 ↗
23. Incidence of injuries in elite French youth soccer players: A 10-season study10.1177/0363546505283271 ↗
24. Smith, J.M., and Varacallo, M. (2024, October 20). Osgood-Schlatter Disease, StatPearls, Available online: https://pubmed.ncbi.nlm.nih.gov/28723024/.
25. Incidence and costs of injuries to children and adults in the United States10.1186/s40621-018-0167-6 ↗
26. Corbi, F., Matas, S., Álvarez-Herms, J., Sitko, S., Baiget, E., Reverter-Masia, J., and López-Laval, I. (2022). Osgood-Schlatter Disease: Appearance, Diagnosis and Treatment: A Narrative Review. Healthcare, 10.10.3390/healthcare10061011 ↗
27. Prevalence and Associated Factors of Osgood-Schlatter Syndrome in a Population-Based Sample of Brazilian Adolescents10.1177/0363546510383835 ↗
28. Is the Prognosis of Os-good-Schlatter Poorer Than Anticipated? A Prospective Cohort Study With 24-Month Follow-up10.1177/23259671211022239 ↗
29. An active boy with bilateral knee pain
30. Increased Posterior Tibial Slope in Patients with Osgood-Schlatter Disease: A New Association10.1177/0363546519899894 ↗
31. Patellar maltracking: An update on the diagnosis and treatment strategies10.1186/s13244-019-0755-1 ↗
32. Muscle stiffness of the rectus femoris and vastus lateralis in children with Osgood-Schlatter disease10.1016/j.knee.2021.08.001 ↗
33. Relationship between the skeletal maturation of the distal attachment of the patellar tendon and physical features in preadolescent male football players10.1007/s00167-012-2353-3 ↗
34. Itoh, G., Ishii, H., Kato, H., Nagano, Y., Hayashi, H., and Funasaki, H. (2018). Risk assessment of the onset of Osgood-Schlatter disease using kinetic analysis of various motions in sports. PLoS ONE, 8.10.1371/journal.pone.0190503 ↗
35. Posterior Tibial Slope is Increased in Patients with Tibial Tubercle Fractures and Osgood-Schlatter Disease10.1097/BPO.0000000000001818 ↗
36. Pathophysiology of Osgood-Schlatter Disease: Does Vitamin D have a Role?
37. Current management strategies in Osgood Schlatter: A cross-sectional mixed-method study10.1111/sms.13751 ↗
38. Osgood-Schlatter disease: A review of current diagnosis and management10.1097/BCO.0000000000001110 ↗
39. Assessment and Treatment of Knee Pain in the Child and Adolescent Athlete10.1016/j.pcl.2014.08.003 ↗
40. Apophysitis of the Tibial Tuberosity (Osgood-Schlatter Disease): A Review
41. Ultrasound Imaging in Diagnosis and Management of Lower Limb Injuries: A Comprehensive Review10.12659/MSM.945413 ↗
42. Bony Maturity of the Tibial Tuberosity With Regard to Age and Sex and Its Relationship to Pathogenesis of Osgood-Schlatter Disease: An Ultrasonographic Study10.1177/2325967117749184 ↗
43. Osgood-Schlatter disease in ultrasound diagnostics—A pictorial essay
44. Morbus Osgood Schaltter10.1016/j.orthtr.2018.10.014 ↗
45. Conservative treatment of Osgood-Schlatter disease among young professional soccer players10.1007/s00264-020-04572-3 ↗
46. Acupuncture in Osgood-Schlatter disease10.1136/bcr-2015-214129 ↗
47. Disability levels of college-aged men with a history of Osgood-Schlatter disease
48. Correlation between Magnetic Resonance Imaging Characteristics of the Patellar Tendon and Clinical Scores in Osgood-Schlatter Disease10.5792/ksrr.2016.28.1.62 ↗
49. Surgical Treatment Outcomes of Unresolved Osgood-Schlatter Disease in Adolescent Athletes
50. Traction apophysitis of the knee: A case report10.1016/j.radcr.2018.09.012 ↗
51. Sinding-Larsen-Johansson syndrome: A case report10.1016/j.jus.2012.03.001 ↗
52. Case report: A rare case of Sinding Larsen-Johansson syndrome in adult10.4103/2600-9404.323209 ↗
53. Sinding-Larsen-Johansson Disease: Analysis of the Associated Factors in the Largest Cohort to Date10.1177/2325967121S00503 ↗
54. Review for the generalist: Evaluation of anterior knee pain10.1186/1546-0096-5-8 ↗
55. Enfermedad de Sinding-Larsen-Johansson: Análisis de factores asociados, [Sinding-Larsen-Johansson disease: Analysis of the associated factors]
56. Sinding-Larsen-Johansson syndrome
57. Overload syndromes of the knee in adolescents: Sonographic findings10.1016/j.jus.2008.09.001 ↗
58. Sinding-Larsen-Johansson syndrome with minimally displaced patellar sleeve avulsion fracture: A case report with multimodality approach and literature review10.1007/s00256-022-04237-9 ↗
59. Sinding-Larsen-Johansson disease. Clinical features, imaging findings, conservative treatments and research perspectives: A scoping review10.7717/peerj.17996 ↗
60. Maladie de Sinding-Larsen-Johansson chez un jeune footballeur10.1016/j.lpm.2015.02.016 ↗
61. Bilateral synchronous Sinding-Larsen-Johansson and Sever Disease in a 10-year-old boy: A case report10.1016/j.jorep.2023.100225 ↗
62. Evaluation and management of knee pain in young athletes: Overuse injuries of the knee10.21037/tp.2017.04.05 ↗
63. Arthroscopic treatment of painful Sinding-Larsen-Johansson syndrome in a professional handball player10.1016/j.otsr.2016.05.011 ↗
64. Sever’s Disease of the Pediatric Population: Clinical, Pathologic, and Therapeutic Considerations10.3121/cmr.2021.1639 ↗
65. Risk Factors and Associated Factors for Calcaneal Apophysitis (Sever’s Disease): A Systematic Review10.1136/bmjopen-2022-064903 ↗
66. Sever’s Disease (Calcaneal Apophysitis)10.1097/TME.0000000000000219 ↗
67. Hernandez-Lucas, P., Leirós-Rodríguez, R., García-Liñeira, J., and Diez-Buil, H. (2024). Conservative Treatment of Sever’s Disease: A Systematic Review. J. Clin. Med., 13.10.3390/jcm13051391 ↗
68. Is Radiographic Evaluation Necessary in Children with a Clinical Diagnosis of Calcaneal Apophysitis (Sever Disease)?10.1097/BPO.0b013e318219905c ↗
69. Sever’s Disease Is One of the Factors Associated with the Onset of Osgood-Schlatter Disease in Japanese Elementary Soccer Players10.1016/j.jsams.2014.11.051 ↗
70. Relación de Lunge y Jack Test En La Apófisis Calcánea (Talalgia de Sever) En Futbolistas Jóvenes
71. Heel Pain: A Systematic Review10.1016/j.cjtee.2015.03.002 ↗
72. Treatment of Calcaneal Apophysitis: Wait and See Versus Orthotic Device Versus Physical Therapy: A Pragmatic Therapeutic Randomized Clinical Trial10.1097/BPO.0000000000000417 ↗
73. Comparison of Braces for Treatment of Sever’s Disease (Calcaneal Apophysitis) in Barefoot Athletes: A Randomized Clinical Trial10.4085/1062-6050-0266.22 ↗
74. Assessment of the Kinesiotherapy’s Efficacy in Male Athletes with Calcaneal Apophysitis10.1186/s13018-017-0637-5 ↗
75. Alfaro-Santafé, J., Gómez-Bernal, A., Lanuza-Cerzócimo, C., Alfaro-Santafé, J.V., Pérez-Morcillo, A., and Almenar-Arasanz, A.J. (2021). Effectiveness of Custom-Made Foot Orthoses vs. Heel-Lifts in Children with Calcaneal Apophysitis (Sever’s Disease): A CONSORT-Compliant Randomized Trial. Children, 8.10.21203/rs.3.rs-20702/v1 ↗
76. Effectiveness of Footwear and Foot Orthoses for Calcaneal Apophysitis: A 12-Month Factorial Randomised Trial10.1136/bjsports-2015-094986 ↗
77. Treatment for Calcaneal Apophysitis
78. Pathophysiology and new strategies for the treatment of Legg-Calve-Perthes disease10.2106/JBJS.J.01834 ↗
79. Legg-Calvé-Perthes disease overview10.1186/s13023-022-02275-z ↗
80. The pathogenesis and treatment of Legg-Calvé-Perthes disease10.2106/JBJS.RVW.15.00063 ↗
81. A case control study to determine the association between Perthes’ disease and the recalled use of tobacco during pregnancy, and biological markers of current tobacco smoke exposure10.1302/0301-620X.99B8.BJJ-2016-1282.R1 ↗
82. Racial and geographic factors in the incidence of Legg–Calvé–Perthes’ disease: A systematic review10.1093/aje/kwr293 ↗
83. Pathophysiology, classifications, and natural history of Perthes disease10.1016/j.ocl.2011.04.007 ↗
84. Role of Advanced Imaging in the Diagnosis and Management of Active Legg-Calvé-Perthes Disease10.5435/JAAOS-D-16-00856 ↗
85. Operative versus nonoperative treatments for Legg-Calvé-Perthes disease: A meta-analysis10.1097/BPO.0b013e318269c55d ↗
86. Perthes disease: Current principles of diagnosis and treatment
87. Management of Patients With Legg-Calvé-Perthes Disease at a Single Center in Jeddah, Saudi Arabia
88. Effectiveness of therapeutic methods for Legg-Calvé-Perthes disease according to staging, limits of conservative treatment: A systematic review with meta-analysis
89. El-Harbiti, A., and Hailer, Y.D. (2020). Range of abduction in patients with Legg-Calvé-Perthes disease - a nationwide register-based cohort study. BMC Musculoskelet. Disord., 21.10.1186/s12891-020-03705-4 ↗
90. Evaluation of physiotherapy in the treatment of Legg-Calvé-Perthes disease10.1590/S1807-59322006000600006 ↗
91. Recommendations for physiotherapy and physical activity for children with Legg-Calvé-Perthes disease: A survey of pediatric orthopedic surgeons and physiotherapists in Sweden10.2340/17453674.2023.18341 ↗
92. Clinical outcomes of conservative treatment with a non-weight-bearing abduction brace for Legg-Calvé-Perthes disease10.1016/j.jos.2017.09.012 ↗
93. Comparison between conservative and surgical treatment in Perthes disease10.1007/s00402-011-1382-6 ↗
94. Conservative versus surgical treatment of late-onset Legg-Calve-Perthes disease: A radiographic comparison at skeletal maturity10.1007/s11832-008-0151-8 ↗
95. Kohler’s disease: An unusual cause for a limping child10.1136/archdischild-2016-311402 ↗
96. Trammell, A.P., Davis, D.D., and Scott, A. (2024, October 22). Kohler Disease, StatPearls, Available online: https://www.ncbi.nlm.nih.gov/books/NBK507831/.
97. Köhler Disease: Avascular Necrosis in the Child10.1016/j.fcl.2018.09.005 ↗
98. Bilateral Kohler’s Disease: A Case Report
99. Kohler’s disease presenting as acute foot injury10.1016/j.ajem.2017.08.004 ↗
100. Osteochondritis of the navicular: A case report10.1177/107110070302400611 ↗