Hefti F
Kinderorthopädische Universitätsklinik, Universitäts-Kinderspital beider Basel, Germany.
Orthopade. 1999 Mar;28(2):173-179. doi: 10.1007/PL00003594.
Foot pain is a relatively common problem in children and adolescents. Most frequently the pain is localized at the heel, the mid- and forefoot are less common sites of discomfort. In this article we discuss the etiology of pain in thoses cases, where the foot has a normal clinical aspect. Sever's disease is most common in adolescents with strenuous athletic activity or with obesity. The calcaneal apophysis is overloaded. Usually the radiologic aspect of the calcis is normal. Treatment consists in reduction of the athletic activity, soft bedding of the heel in the shoes and reduction of weight. Avascular necrosis of the metatarsal head II or III (Freiberg's disease) is also relatively common, while necrosis of the navicular bone (Köhler's disease) is very rare. Treatment in these cases is always conservative. Pain can also originate from tarsal coalition. While in the beginning the foot has a normal aspect, lateron a rigid flatfoot can develop. In unclear cases stress fractures of the metatarsal bones, infections and tumors also have to be considered.
足部疼痛在儿童和青少年中是一个相对常见的问题。疼痛最常出现在足跟，而中足和前足较少出现不适。在本文中，我们讨论足部外观正常情况下这些病例疼痛的病因。Sever病在剧烈运动或肥胖的青少年中最为常见。跟骨骨骺负荷过重。通常跟骨的放射学表现正常。治疗包括减少体育活动、在鞋中使用柔软的足跟衬垫以及减轻体重。第二或第三跖骨头缺血性坏死（弗赖贝格病）也相对常见，而舟骨坏死（科勒病）则非常罕见。这些病例的治疗通常是保守的。疼痛也可能源于跗骨联合。起初足部外观正常，后来可能发展为僵硬扁平足。在不明确的病例中，还必须考虑跖骨应力性骨折、感染和肿瘤。
