Recently, I saw a healthy, active young teenage male in the office for leg pain and flatfeet. He was having issues after running and sports activity. At age 15, he was already 6’4”! In addition to lower leg pain, he was having classic symptoms related to Osgood-Schlatter’s (caused by stress on the patellar tendon that attaches the quadriceps muscle at the front of the thigh to the tibial tuberosity). Some of his pains were attributed to “growing pains”.
As with all our pediatric patients, we took x-rays for a baseline assessment. Now, I expected to see normal growth plates at different areas and some joint misalignments that correspond to his flat feet. Boy was I surprised!!
It turns out that he had a large bone cyst that was roughly 50% of his lower tibia (the larger of his lower leg bones). This was an area he wasn’t really conveying issues with. After looking at his x-rays, I started to do a more focused exam to this specific area, which expectedly turned out to be painful with pressure and touch. I had to pull him out of all sports immediately due to his risk of completely breaking the bone with just the right motion or impact!
So this stresses the point that for growing kids, we don’t accept the term “growing pains”. Although the incidence of bone tumors in kids is fairly low, you just never know! It’s better to be suspicious and be wrong, than to be careless and miss something big!
With this incident in mind, I wanted to write a little bit about Bone tumors to better educate our patients.
There are two general classifications of tumor types, which are:
Benign Tumors – These are non-cancerous masses, which do not spread from their original sites to any other parts of the body.
Malignant Tumors – These are the more dangerous masses, which are considered cancerous. The dangerous component of malignant tumors is the spread of uncontrollable dividing cells to other parts of the body, this is known as Metastasis.
The most common group of tumors that arise within the skeleton of children between the ages of 6-12 are Benign Bone Tumors.
There are three main types of Benign Bone Tumors that often appear in children, which are:
Osteochondromas – This is the most common benign tumor of the foot and is usually located under the toenail. The tumor may cause deformities to the toenail, such as an ingrown toenail or irritation to the surrounding tissue, but are not typically painful. This type of tumor growth also appears in the metaphysis of long bones such as the Femur and Tibia in children.
Unicameral Bone Cysts – This is a different type of tumor that forms from the presence of excess tissue and fluid, which fills a hole in the bone. This type of tumor is usually found after fracturing a long bone, such as the tibia and upper portion of the femur.
Nonossifying Fibromas – This type of tumor growth appears in actively growing sections of long bones, such as an actively growing section of the femur or tibia.
Benign Bone tumors are usually asymptomatic and rarely need surgery because they go away on their own. However, these tumors could put your child at a greater risk of injury or growth problems from the resulting weak spot in the bone. Also, benign tumors should be monitored just in case the growth becomes too large and causes pain or pinches any surrounding nerves.
Malignant Bone Tumors are cancerous tumors called Sarcomas, which are less common in children. However, these tumors are dangerous because over time, the cancerous cells of these tumors find their way into the blood and can spread to vital organs, such as the lungs. These cancerous cells can destroy the limb of the tumors location and can be life threatening when they spread to other parts of the body.
There are two main types of Malignant Bone Tumors that often appear in children, which are:
Osteosarcomas – This is the most common malignant bone tumor in children and young teens. These malignant tumors arise from mesenchymal cells, which are responsible for the formation of bone. Therefore, these tumors primarily affect immature bone, such as the rapidly growing metaphyseal regions of bones in children.
Ewing Sarcomas – This is the second most common malignant bone tumor in children and young teens. These tumors tend to be very aggressive and arise from neuroectodermal cells that affect the metaphyseal regions of bones in the lower extremity of children.
The key symptom for both Osteosarcomas and Ewing Sarcomas is the presence of pain at the affected site. Swelling and weight loss are other key findings in Ewing Sarcomas. Regardless of the severity of symptoms associated with malignant tumors, it is your responsibility to take action because these cancerous cells can spread to your child’s vital organs and cause serious damage or even worse, death.
Therefore, if your child is complaining about pain in a localized region of their bone or you notice an abnormal lump on their limb then it is crucial that you contact your podiatrist as soon as possible. Bone tumors can be extremely challenging to find and diagnose correctly, so your podiatrist may use multiple imaging tests in combination with assessing the tumors location and your child’s age to determine the best course of action. An accurate, early diagnosis and treatment plan significantly enhances the success rate for treating malignant bone tumors.