Ways To Spot Calcaneal Apophysitis?

Overview


The large heel bone (called the calcaneus) has a growth plate at the back of the heel. This growth plate is made of soft cartilage and it gradually narrows and starts to turn into solid bone around 8 to 13 years of age. This growth plate is prone to becoming inflamed and painful at this time. The strong Achilles tendon happens to join onto the back of the heel bone and pulls on this growth plate when running causing Sever?s disease.


Causes


This condition is more common in boys than girls. It generally presents between the ages of 9-14 and peaks between ages 10-12 years. This injury can reoccur up until the age of 17, when the growth plate of the calcaneous generally closes. These types of injuries will commonly occur during periods of rapid growth. Sever?s Disease occurs more frequently in child with flat feet, but all children with flat feet will not get Sever?s.


Symptoms


Sever's disease usually develops gradually. The pain from Sever's disease is often intermittent and localized to the area where the Achilles tendon attaches to the calcaneus. Swelling may be noted in this area. There can be tenderness on squeezing the calcaneus or pain when trying to stretch the calf muscles. Occasionally there is night pain. As Sever's disease progresses there can be continuous pain.


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


Orthotics or special shoe inserts can also be used to cushion the heel and reduce pain. Physical Therapy. If avoiding physical activities fails to clear up Sever?s disease Genesis Orthopedics & Sports Medicine may proceed with physical therapy. Physical therapy strengthens the muscles and tendons in the heel, releasing pressure and eventually reducing pain.


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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Janey Lindau

Author:Janey Lindau
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