Calcaneal Apophysitis The Facts

Overview

Sever?s Disease is one of the most common overuse injuries affecting children during their secondary growth spurts and is described as a self-limiting condition resolving naturally with skeletal maturity 1. It is suggested to be caused by progressive microtrauma to the bone-cartilage interface in the calcaneal apophysis partly due to large traction forces in the Achilles tendon. The current standard treatment consists mainly of rest, and waiting for skeletal maturity.

Causes

The heel bone grows faster than the ligaments in the leg. As a result, muscles and tendons can become very tight and overstretched in children who are going through growth spurts. The heel is especially susceptible to injury since the foot is one of the first parts of the body to grow to full size and the heel area is not very flexible. Sever?s disease occurs as a result of repetitive stress on the Achilles tendon. Over time, this constant pressure on the already tight heel cord can damage the growth plate, causing pain and inflammation. Such stress and pressure can result from, Sports that involve running and jumping on hard surfaces (track, basketball and gymnastics). Standing too long, which puts constant pressure on the heel. Poor-fitting shoes that don?t provide enough support or padding for the feet. Overuse or exercising too much can also cause Sever?s disease.

Symptoms

As a parent, you may notice your child limping while walking or running awkwardly. If you ask them to rise onto their tip toes, their heel pain usually increases. Heel pain can be felt in one or both heels in Sever's disease.

Diagnosis

Sever's disease is based on the symptoms reported. To confirm the diagnosis, the clinician will examine the heels and ask about the child's activity level and participation in sports. They may also squeeze the back part of the heel from both sides at the same time to see if doing so causes pain and also ask the child to stand on tiptoes to see if that position causes pain. There may be tightness in the calf muscle, which contributes to tension on the heel. Symptoms are usually worse during or after activity and get better with rest. X-rays generally are not that helpful in diagnosing Sever's disease, but they may be ordered to rule out other problems, such as fractures. Sever's disease cannot be seen on an X-ray.

Non Surgical Treatment

Most patients with Sever?s Disease can be treated with a self-guided home exercise program. Your healthcare provider will discuss with you if a prescription for formal physical therapy is indicated instead of a self-directed home or school exercise program. Rest (protection of the heel). Ice (Ice 20 minutes at a time, 2-3 times a day). Gel heel pads / inserts. Anti-inflammatory medication. Well cushioned pair of shoes. Brace (Cheetah) *Generally given for those who cannot wear shoes during their sport. Low impact aerobic training such as walking, riding a bike, elliptical or swimming. Home exercise program focusing on increasing the flexibility of the heel cord and calf muscle.

Prevention

Having Sever?s disease does not predispose children or teens to any other condition, nor is it a permanent problem. It is self-limiting, and when treated, the pain and other symptoms will abate within a few weeks. Once the growth plate has finished growing, Sever?s disease will resolve and won?t recur. It is important to continue to treat any underlying foot conditions and to avoid any long periods of inactivity.

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