Calcaneal Apophysitis The Facts

Overview

Sever?s disease (also known as calcaneal apophysitis) is a type of bone injury in which the growth plate in the lower back of the heel, where the Achilles tendon (the heel cord that attaches to the growth plate) attaches, becomes inflamed and causes pain. Sever?s disease is the most common cause of heel pain in children, especially those who exercise or play sports on a regular basis.

Causes

Sever’s disease is a common cause of heel pain in physically active growing kids. It usually occurs during the growth spurt of adolescence, the approximately 2-year period in early puberty when kids grow most rapidly. This growth spurt can begin anytime between the ages of 8 to 13 for girls and 10 to 15 for boys. Peak incidences are girls, 8 to 10 years old. boys, 10 to 12 years old.

Symptoms

The most obvious sign of Sever’s disease is pain or tenderness in one or both heels, usually at the back. The pain also might extend to the sides and bottom of the heel, ending near the arch of the foot. A child also may have these related problems, swelling and redness in the heel, difficulty walking, discomfort or stiffness in the feet upon awaking, discomfort when the heel is squeezed on both sides, an unusual walk, such as walking with a limp or on tiptoes to avoid putting pressure on the heel. Symptoms are usually worse during or after activity and get better with rest.

Diagnosis

Sever’s disease is diagnosed based on a doctor?s physical examination of the lower leg, ankle, and foot. If the diagnosis is in question, the doctor may order X-rays or an MRI to determine if there are other injuries that may be causing the heel pain.

Non Surgical Treatment

The aim of treatment is to reduce the pain and inflammation when gently stretch the muscles. There is likely to be no magic instant cure and the young athlete may have to be patient while they grow. Rest and apply ice or cold therapy to the heel. Do not apply ice directly to the skin but wrap in a wet tea towel to avoid ice burns. Rest from activities which cause pain. If running and playing football makes it worse then reduce or stop this activity and try cycling or swimming to maintain fitness. A temporary measure is to insert a heel pad or heel raise into the shoes. This has the effect of raising the heel and shortening the calf muscles and so taking the strain off the back of the heel. However long term use of a heal raise may shorten the calf muscles when they need stretching. Stretch the calf muscles regularly. Stretching should be done pain free and very gently with this injury. See a sports injury professional who can advise on treatment and rehabilitation.

Prevention

Sever’s disease may be prevented by maintaining good joint and muscle flexibility in the years leading up to, and during, their growth spurts (eg girls 8 to 10, boys 10 to 12). Foot arch problems such as flat feet should be addressed after the age of five if they don’t appear to be self-correcting. If you are concerned, please ask your health practitioner. The most important factor is the amount of weight-bearing exercise your child is currently performing.

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