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What Exactly Is Calcaneal Apophysitis?

Overview

Severs disease or calcaneal apophysitis causes heel pain usually in growing children between age nine and fourteen. It occurs as a result of disturbance during the final development of the heel growth plate. During this time the achilles tendon is pulling strongly on the heel bone and this excessive force can cause inflammation and pain.

Causes

Sever's disease usually develops as a result of overuse and is common in active children between the ages of 8 to 12. Activities that involve running or jumping can cause undue stress on the calcaneal apophysis. This in turn leads to the development of microscopic damage to the calcaneal apophysis resulting in inflammation and pain. Poor flexibility of the calf muscles and of the Achilles tendon, overpronation (feet rolled in) and inappropriate footwear are some of the other factors that can cause Sever's disease.

Symptoms

Pain is usually related to activity levels. In most cases the posterior aspect of the calcaneus will be tender. Checking both the medial and lateral aspects of the posterior portion of the growth plate will often show tenderness. Occasionally, the plantar aspect may be tender or both of these locations may be found to be tender. Frequently the Achilles tendon is tight and there may have been a recent increase in activity. The factors contributing to this disorder are similar to those causing plantar fasciitis, but a tight Achilles tendon appears to be a greater contributor than pronation.

Diagnosis

Sever?s disease can be diagnosed based on your history and symptoms. Clinically, your physiotherapist will perform a "squeeze test" and some other tests to confirm the diagnosis. Some children suffer Sever?s disease even though they do less exercise than other. This indicates that it is not just training volume that is at play. Foot and leg biomechanics are a predisposing factor. The main factors thought to predispose a child to Sever?s disease include decrease ankle dorsiflexion, abnormal hind foot motion eg overpronation or supination, tight calf muscles, excessive weight-bearing activities eg running.

Non Surgical Treatment

Fortunately Severs? disease can be treated and prevented through a number of different techniques that have all proven highly effective. The heel will repair itself even without active treatment provided that the suffering foot is given a chance to heal. Typically Severs? disease will take 2-8 weeks, although in many cases it can take longer as the continuous growing of the bone can exacerbate the condition. Podiatrists have an important role in preventing Severs? disease in young athletes, and in treating the condition when it develops so children can get back on their feet as quickly as possible. Generally treatment involves stretching muscles running down to the heel to relieve tension and pain, these include the hamstrings and calf muscles, and these stretching exercises will need to be performed at least 2 or 3 times a day. RICE is a classic method of speeding up the recovery of self-healing injuries like Severs? disease. This involves Rest, the application of Ice to the injury, Compression, and finally Elevation to encourage repaid. These measures can be advised by a trained podiatrist, but it is then up to a child to carry on with regular RICE.

Surgical Treatment

The surgeon may select one or more of the following options to treat calcaneal apophysitis. Reduce activity. The child needs to reduce or stop any activity that causes pain. Support the heel. Temporary shoe inserts or custom orthotic devices may provide support for the heel. Medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, help reduce the pain and inflammation. Physical therapy. Stretching or physical therapy modalities are sometimes used to promote healing of the inflamed issue. Immobilization. In some severe cases of pediatric heel pain, a cast may be used to promote healing while keeping the foot and ankle totally immobile. Often heel pain in children returns after it has been treated because the heel bone is still growing. Recurrence of heel pain may be a sign of calcaneal apophysitis, or it may indicate a different problem. If your child has a repeat bout of heel pain, be sure to make an appointment with your foot and ankle surgeon.
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