What are the effective treatments for growth-plate pain (apophysitis) in hips, legs, or feet?

Key messages

• Most children with growth-plate pain (apophysitis) get better over time. Whether treatment for apophysitis affects short-term pain, physical function, and participation in sport is uncertain.

• It is uncertain whether any treatment is better or worse than any other. The studies were mostly small and had problems with their design. The studies did not always measure unwanted effects from a treatment, and none measured whether any children withdrew from studies because of unwanted effects.

• The evidence is limited. Most studies included more boys than girls, and included children who were more active than average. The children often knew which treatment they were receiving, which may have influenced the results.

What is apophysitis?

During puberty, children sometimes develop pain in the growth plates in their hips, knees, and feet. This pain is usually caused by irritation of the growth plate from repeated stress over time rather than from a single event. The pain is usually short-term and has limited impact on a child's life. However, sometimes the pain can make children limp, play less sport, or be less physically active. The conditions are called different names based on the location of the growth, but are commonly known as 'apophysitis' or 'lower limb apophyseal injuries'.

How is apophysitis treated?

Many different healthcare professionals treat apophysitis, including general practitioners or physicians, physiotherapists, and podiatrists. Many treatments are used, including exercises, medicines, strapping, braces, or devices put in shoes like foot orthoses or heel lifts. Regardless of treatment, apophysitis usually gets better on its own, but in some cases, the pain can last for a long time.

What did we want to find out?

We wanted to find out which treatments reduce pain effectively and to understand how safe these treatments are. We wanted to know which treatments improve how children function physically and take part in sport. We also wanted to know if one treatment worked better than another.

What did we do?

We searched for studies that tested the different types of treatments for apophysitis in the hip, knee, and foot. We did not search for any treatments that involved surgery.

We combined results from studies that tested the same treatments and used similar methods to measure effectiveness. We rated our level of certainty about this evidence.

What did we find?

We found 10 studies that involved 654 children whose average age ranged from 10.3 to 13.3 years. Seven studies focused on heel pain (calcaneal apophysitis), and three focused on pain in the front of the knee (traction apophysitis of the tibial tubercle).

Main results

• One study (23 children) compared a medicine called dexamethasone to a placebo (fake treatment). We are very uncertain whether dexamethasone reduces pain, improves physical function, or helps children return to sport in the short term. Two studies (74 children) reported unwanted effects of medicines, but the evidence was also very uncertain.

• One study (21 children) compared dexamethasone to usual care. We are very uncertain whether dexamethasone reduces pain, improves physical function, or helps children return to sport in the short term. One study (30 children) reported unwanted effects, but the evidence was also very uncertain.

• One study (22 children) compared Kinesio tape to a placebo. We are very uncertain whether Kinesio tape improves pain or physical function in the short term. The study did not report on participation in sport or unwanted effects.

• One study (124 children) compared foot orthoses to heel lifts. It found that there is probably little to no difference between them in terms of pain or physical function in the short term. The study did not report on participation in sport. One study (101 children) reported that there were no unwanted effects.

• One study (43 children) compared heel cushioning to a heel strap. We are very uncertain whether heel cushioning improves physical function or causes any unwanted effects in the short term. The study did not report on participation in sport.

• None of the studies reported whether any children withdrew from the studies because of unwanted effects.

What are the limitations of this research?

• In most studies, the children and carers knew which treatments they were receiving, which may have influenced how they reported improvements. This may affect how reliable the results are.

• Apophysitis often improves on its own as children continue to grow and the growth-plates close, so it is difficult to know if any improvements are due to treatments or natural recovery over time.

• There were many more boys than girls in the studies, and most participants were very physically active. It is unlikely that the condition impacts boys and girls differently, but we are unsure if our findings can be applied to children who are less physically active.

• Finally, most studies had only a small number of participants. This means we cannot be confident in the results and cannot know whether the findings would apply to a wider group of children with apophysitis.

How up to date is this evidence?

The evidence is current to 4 January 2025.