Can I Address Calcaneal Apophysitis From Home?

Overview

Sever?s disease is a condition that occurs in children during the growth spurt of adolescence, typically between the ages of 8 and 13 for girls and 10 and 15 for boys. It is often painful but can be treated early with good results. Sever?s disease occurs when the growth plate in the heel begins to swell. Sever?s disease often occurs during the same period in a child?s growth as Osgood-Schlatter disease.

Causes

Severs disease is caused by repetitive excessive force to the growing area of the heel bone, causing injury to this area. The calf muscles (soleus and gastrocnemius) are attached by the Achilles tendon to the calcaneus (heel bone). They exert a huge force during running , jumping and landing. In children, there is a growing area in the heel bone called the apophysis and is made of relatively weak cartilage. If there is excessive force at this relatively weak point damage occurs. This excess force can be caused by a number of factors. During the adolescent growth spurt the bones grow very quickly. The muscles do not grow out at the same rate as the bone grows and so can become very tight. The calf muscles generate huge forces when they are used to run, jump and land. This force is transmitted to the calcaneal apophysis (growth area). The gastrocnemius muscle spans both the ankle and knee joint. Tightness of this or any other muscles of the lower limb (hamstring or quadriceps) cause extra force at the growing (weak) area. In active children, who undertake a lot of exercise, the repetitive high force causes damage. If your child has poor biomechanics due to poor lower limb alignment (often caused by flat feet), the muscles of the lower limb have to work excessively hard and this can cause increased force at the tibial tubercle.

Symptoms

Signs and symptoms of Sever?s disease include heel pain can be in one or both heels, and it can come and go over time. Many children walk or run with a limp, they may walk on their toes to avoid pressure on their heels. Heel pain may increase with running or jumping, wearing stiff, hard shoes (ex. soccer cleats, flip-flops) or walking barefoot. The pain may begin after increasing physical activity, such as trying a new sport or starting a new sports season.

Diagnosis

Sever disease is most often diagnosed clinically, and radiographic evaluation is believed to be unnecessary by many physicians, but if a diagnosis of calcaneal apophysitis is made without obtaining radiographs, a lesion requiring more aggressive treatment could be missed. Foot radiographs are usually normal and the radiologic identification of calcaneal apophysitis without the absence of clinical information was not reliable.

Non Surgical Treatment

Depending on the underlying cause, treatment can include. Arch supports (foot orthoses) to correctly support the feet. Proper taping of the foot and heel. Rest from activities. Icing at the end of the day. A night splint worn at night. Flexibility exercises and strengthening. Ultrasound therapy. Anti-inflammatory drugs.

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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