Enthesitis and Enthesopathy in Childhood

Entheseal abnormalities and entheisis organ dysfunction is not uncommon in childhood.

The particular problem in the paediatric population is that the bones have not fused together and remain relatively mobile. This traction exerted by the enthesis on the underlying bone is analogous to the traction the roots of a tree can lead to bony fragments been pulled off.

This manifests as what are termed avulsion fractures where a fragment of bone is literally pulled off after major trauma. Repeated low grade trauma commonly leads to entities including Osgood-Schlatter disease or a traction of enthesopathy of the patellar tendon.

Severs disease is a traction enthesopathy that occurs at the achilles region. Fibres of the achilles enthesis and plantar fascia are connected in the heel and this allows for movement in two directions which maybe especially pertinent in this condition.

The third major related type of enthesopathy is that associated with inflammation or enthesitis that can occur in young patients and typically in the lower limbs.

This is characterised by pain and stiffness and maybe associated with joint swelling symptoms are most protracted in the morning. Consultation with a paediatric rheumatologist is recommended to help differentiate these conditions.

"Growing pains" may also be linked to the enthesis.

This section covers childhood enthesopathies.