Climbing Injuries in Children: Fingers and Toes

You may remember our guest blogger Tom Bond’s recent article; “Are your climbing shoes to tight?” It generated so much interest we invited him back to write a short series of articles about our bodies and climbing. This month the subject is Children and the injuries they pick up through too much intensive climbing.

If your child climbs this is essential reading for you.

But first of all lets introduce Tom again:

I’m Thomas Bond, I’m a physiotherapist who works full time in the NHS in Kent. Outside of work, I have a special interest in rock climbing injuries and enjoy teaching others about injuries and rehab for them. I’ve attended both BMC Climbing Injury Symposiums in 2010 and 2012, and in 2012 presented my dissertation on grip strength in rock climbers. I am also an active member of the BMC and get out on rock whenever I can.

Check out my blog for more information on injuries, and if you have any problems, feel free to email me, or follow me on twitter @tombondphysio

Young Climbers: Fingers and Toes

Getting children involved in climbing is fantastic, especially as climbing can be viewed as a life-long sport. However, we’d like to keep it that way, and the process to do this is prevent any injuries that will impact the kids in the future.

The main problem with injuries in children is any damage to the growth plates of any kind, and the most likely growth plate to injure is those that are sustaining high stress forces through them, such as the fingers. This post will aim to explain what growth plates are, the incidence of these injuries, and how best to avoid them. It will then be followed by information on the impact on climbing shoes on a child’s foot.

Remember, children are children, not just “mini adults”!!!

What are growth plates?

As a child grows, all their bones start of as cartilage, and develop into bone as they get older. This is why a child’s rib cage is much bouncier than an adults (please don’t test this out!). This is why children are more likely to get greenstick fractures than pure fractures (this is where the bone bends and splinters, rather than a pure breakage – try this out with a freshly cut tree branch and try and snap it). As these bones develop, there are areas where the bone needs to grow.

The epiphyseal plate (or growth plate) is where new bone is formed to make the bone grow in a longitudinal direction, and on the otherside of the plate, the new bone growth becomes calcified. There is one of these growth plates at either end of the growing bone.

 

Growth Plates

Growth Plates

When this growth plate is damaged, the growth of the bone can be changed, from direction, to rate of growth or even stop growth altogether. Whilst growth plates are still growing, they are the weakest area of the growing skeleton, 2 to 5 times weaker than adjacent ligaments. This is due to the connective tissues needing to allow for the growth of the bones. Once growth has stopped, the epiphyseal plate is replaced with solid bone through calcification, and ceases to be an area of weakness. Obviously, weight bearing is key for bone development and growth, however, it is the overuse and over-stressing of these structures that we are concerned about.

Time line of growth plates

If I remember correctly, during the closure of growth plates, the larger bones will fuse first, then the smaller joints. Also, the dorsal aspect of the growth plate closes last.

Finger

This means that the fingers are susceptible to injury longer than larger bones such as the femur or humerus, and the dorsal aspect of the epiphyseal plate is usually where an overuse injury will occur in a child’s finger.

15 year old Salter 3 lesion

The picture above demonstrates this area of weakness, with a grade 3 Salter-Harris fracture.

Fingers stop growing at a biological age of 17 years old, but key timings to note is that of growth spurts, occurring from around age 12-13 for girls, and 13-15 for boys.

Especially for boys, this is key to note, as  growth spurt plus testosterone = temptation to train harder due to the ease in which muscle bulk is put on in this period.

Incidence of growth plate injuries

Amongst junior competition climbers studied within the German National Junior Team by Volker Schoffl and friends found two-thirds who trained regularly on the campus board got fractured growth plates in a finger.

Shigeo Omori and Hajime found over 3 years, 182 junior competition climbers aged 7 to 19 had their fingers medically examined and 77.6% of these climbers had abnormalities, mostly deformation and light flexion contracture (can’t place hand flat on table).

In general, non-climbing public:

Growth-plate injuries comprise 15 percent of all childhood fractures. They occur twice as often in boys as in girls, with the greatest incidence among 14- to 16-year-old boys and 11- to 13-year-old girls. Older girls experience these fractures less often because their bodies mature at an earlier age than boys. As a result, their bones finish growing sooner, and their growth plates are replaced by stronger, solid bone.

Approximately half of all growth plate injuries occur in the lower end of the outer bone of the forearm (radius) at the wrist. These injuries also occur frequently in the lower bones of the leg (tibia and fibula). They can also occur in the upper leg bone (femur) or in the ankle, foot, or hip bone.

Mechanism of injury

The Mechanism of injury can be acute injury such as a fall, or can be a chronic onset caused by intense training, campus boarding or over-use of the crimp hold grip which causes compression or shearing of the growth plate.

It has been found that these injuries normally occur in climbers within the training scenarios rather than competitions.

Crimping or campus boarding has been found to be a cause of growth plate injuries due to the high loads put through the fingers, therefore causing an overload of growth plate (repetitive stress).

Signs and symptoms

  • Lack of mobility in fingers
  • Constant pain
  • Chronic swelling
  • Lack of crimping ability due to pain/swelling
  • The old mandate of “No pain, no gain” is crazy! If it hurts, get it checked out!

plate injuries fingers

Diagnosis of injuries

The diagnosis and classification of a growth plate injury is normally via x-ray, and is classified as 1 to 5 Salter-Harris fracture.

Salter Harris classification

Treatment

As with all fractures, this depends on the severity of the fracture, but will probably comprise of:

  • Immobilization
  • Manipulation or surgery
  • Strengthening/Range of movement exercises

 Implication of these injuries

Continued climbing despite advice

 

  • Rotation/shortening of finger
  • Incomplete growth
  • Deformity
  • Some papers suggest there is a link between climbing from an early age and early degenerative changes later on in life such as arthritis.

These will all obviously affect the child later on in life.

How to avoid these injuries

  • Avoid campus boarding under 18 years of age. Many famous climbers never touch a campus board – Steve Mclure, Tyler Landman so why does the kid?!
  • Excessive Crimping – try and promote versatile grip strengths
  • Long / intense training sessions
  • No need to train specifically for strength pre-pubescent – due to  motor skills still need to catching up with growth spurt.
  • Avoid additional weight when climbing
  • Dynamic moves – limit
  • When training, try to discourage unorganised competition, as it will often leads to someone getting an injury
  • Train other areas, such as core, antagonists, balance, movement technique
  • Respect growth spurts
  • Maintain good nutrition
  • No campus boarding (feet-off or dynamically) for under 18’s! (to allow margin of error for late developers)  UIAA approved advice!

Feet and Toes – the impact of climbing shoes on children

“The foot is the foundation, and if that isn’t working correctly, nothing will”

Now to discuss the impact of rock climbing footwear on a child’s feet, especially due to the growing market of climbing shoes available for the younger climber.

The first thing to note is the rate of growth in children’s feet.

In girls, the foot grows linearly fashion in both width and length from 3 to around 12 years old, and stop growing completely around 14 years old.

In boys, the foot grows in a linear fashion in both width and length from 3 to around 15 years old, and stop growing around 16 years old.

 

Measuring-childrens-feet-is-important-to-ensure-the-perfect-fit

A child’s foot can grow 3 sizes in a year, so it is really important to monitor growth closely.

Children’s feet also sweat more, so need more ventilation from their chosen footwear to prevent poor foot hygiene.

A study done into the German Junior National Team found a higher incident of hallux valgus in those members who had spent a relatively longer time active in indoor competition climbing, as well as 74% of the team having feet pressure marks compared to 28% recreational climbers, indicating tight fitting shoes (even though the importance of tight fitting shoes in indoor walls is less important due holds being relatively larger than outdoors, enabling children to wear shoes too long if required).

Another problem with the climbing shoes is the supinated foot position as mentioned in the previous foot and ankle post, which can put a child more at risk of ankle injuries. With children, this puts them more at risk of ankle growth plate injuries, as mentioned above.

Salter Harris 2010

Rigid shoes or too much cushioning can limit the development of the connective tissue, muscles and bones, due to these structures requiring the mechanical stimuli to aid the growth. This is especially important as the connective tissue strength and foot flexibility does not stop forming until the age of 15.

Finally, shoes that do not cut into Achilles tendon are recommended, as this can cause shortening of the tendon when the calf is flexed, causing torsion in the plantar fascia leading to a higher arch causing a change in the biomechanics of the foot.

Any children’s shoes that are too tight or too small will limit the growth of a child’s foot at the key stages of their development. A poorly developed foot will impact a child for the rest of their life.

In summary, a child’s climbing shoe needs to be:

  • flexible
  • not cutting into the Achilles tendon
  • not too much cushioning
  • not restrictive
  • needs ventilation
  • review the sizing often

I hope this post has made you aware of the complications climbing can have on a child, not to put them off of climbing, but so that you, as an adult, can keep an eye out for them, as they can’t often make you aware of a problem, and what it may mean.

For more information and advice on fitting children’s climbing shoes, read our “Children’s climbing shoe buying guide“.

References