Medically reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatric Surgeon — Balance Foot & Ankle, Howell & Bloomfield Hills, MI. Last updated April 2026.

Foot & Ankle Injuries in Youth Athletes: Prevention & Treatment

Young athletes are not simply small adults when it comes to injury risk and management. The presence of open growth plates, rapid skeletal growth, and developing musculotendinous systems creates a unique set of injury patterns that require specific knowledge to manage safely. Podiatrists who work with pediatric and adolescent athletes must understand these differences — and parents of young athletes deserve to understand why “the same thing” that would be managed one way in an adult is treated differently in a child.

Why Young Athletes Are Different

Open Growth Plates

Until adolescence is complete (typically ages 14–18), the long bones of the foot and ankle contain growth plates (physes) — zones of cartilage at the ends of bones where growth occurs. Growth plate cartilage is significantly weaker than the surrounding bone and ligaments. This means that force that would sprain a ligament in an adult may instead fracture through the growth plate in a child. Growth plate fractures must be identified and properly managed to prevent growth disturbance.

Rapid Skeletal Growth

During growth spurts, bones grow faster than their attached muscles and tendons, creating relative tightness. This is the mechanism of Sever’s disease (calcaneal apophysitis) — the Achilles becomes relatively tight as the heel bone grows, pulling on the heel’s growth plate. Similar phenomena occur at other apophyses.

Bone Remodeling Capacity

Young bone remodels more completely after fracture — minor malunions that would be permanent in adults may spontaneously correct in children. However, this doesn’t apply to growth plate injuries, which can permanently alter bone growth if improperly managed.

Common Injuries by Anatomical Location

Heel — Sever’s Disease (Calcaneal Apophysitis)

The most common foot injury in active children ages 8–14. Achilles tightness during growth spurts causes pain at the heel’s growth plate. Bilateral in 60% of cases. Treatment: heel cups, calf stretching, activity modification. Resolves completely when growth plates close. (See our full guide on Sever’s disease.)

Fifth Metatarsal — Iselin’s Disease and Avulsion Fractures

The base of the fifth metatarsal has a secondary growth center (apophysis) in adolescents. Iselin’s disease (apophysitis) causes pain at the outer midfoot. Acute avulsion fractures occur when the ankle rolls and the peroneus brevis pulls off the fifth metatarsal base. These are often misread as simple ankle sprains on X-ray — the avulsion fracture runs parallel to the bone, while a Jones fracture (at the same location in adults) runs perpendicular.

Ankle — Tillaux and Triplane Fractures

As the distal tibial growth plate closes during late adolescence (ages 12–15), it closes in a specific pattern — leaving transitional portions still open. This creates vulnerability to unique fracture patterns unique to this age group:

• Tillaux fracture: Avulsion of the anterolateral tibial epiphysis
• Triplane fracture: Complex fracture in three planes simultaneously, unique to the transitional ankle

Both require CT scan for full characterization and often need surgical fixation to restore articular congruence and prevent growth disturbance.

Second Metatarsal — Stress Fractures

Stress fractures of the second metatarsal are common in young dancers, gymnasts, and distance runners. The stress fracture may be invisible on initial X-ray — MRI or bone scan is required when clinical suspicion is high. Treatment requires 4–6 weeks of offloading.

Navicular Stress Fractures

The navicular (midfoot) is a high-risk stress fracture site in elite young athletes, particularly in track and field. These fractures are notoriously slow to heal and have high non-union rates if inadequately treated. Weight-bearing must be prohibited until healing is confirmed — not just when symptoms resolve.

Prevention Strategies for Youth Athletes

Appropriate Progression

The 10% rule applies to young athletes: weekly training volume should not increase more than 10% per week. Adolescent athletes who dramatically increase mileage or training intensity (e.g., at the start of a new season) are at highest risk for overuse injuries.

Rest and Recovery

Year-round single-sport specialization is associated with significantly higher overuse injury rates in youth athletes. Seasonal variation in sports allows different muscle groups to rest and recover.

Appropriate Footwear

Sport-specific footwear that’s replaced regularly (before visible wear-through) is essential. Children’s feet change size rapidly — shoes should be checked for fit every 3 months in younger children.

Addressing Biomechanical Issues Early

Young athletes with flat feet, high arches, or leg length discrepancy who participate in high-impact sports benefit significantly from early orthotic intervention. Addressing these issues before the overuse injury occurs is far better than treating the injury after the fact.

When to See a Podiatrist

Don’t wait when a young athlete is injured. Growth plate fractures, in particular, require prompt evaluation. Bring your child to us if:

• Pain doesn’t resolve within 1–2 weeks of rest
• There is point tenderness over a bone (not just soft tissue)
• Significant swelling and bruising after an injury
• The athlete is limping or refusing to bear weight
• A “sprained ankle” that isn’t improving after 2 weeks

Related Conditions

• Sever’s Disease in Children
• Custom Orthotics for Young Athletes
• Flat Feet in Children

Ready to Get Relief? Book an Appointment Today.

Board-certified podiatrists Dr. Tom Biernacki, Dr. Carl Jay, and Dr. Daria Gutkin see patients daily at our Howell and Bloomfield Township, MI offices.

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Sports injuries in growing feet need specialized care. Our podiatrists understand pediatric biomechanics and help young athletes recover safely and prevent re-injury.

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Clinical References

1. Soprano JV, et al. Musculoskeletal injuries in the pediatric and adolescent athlete. Curr Sports Med Rep. 2005;4(6):329-334.
2. Caine D, et al. Epidemiology of injury in child and adolescent sports. Pediatr Ann. 2006;35(6):410-417.
3. Micheli LJ. Overuse injuries in children and adolescents. Med Sci Sports Exerc. 2006;38(2):206-212.