Diagnosing Calcaneal Apophysitis
Overview
Sever's disease occurs in children when the growth plate (which is the growing part of the heel) is injured. The foot is one of the first body parts to grow to full size. This usually occurs in early puberty. During this time, bones often grow faster than muscles and tendons. As a result, muscles and tendons become tight. The heel area is less flexible. During weight-bearing activity (activity performed while standing), the tight heel tendons may put too much pressure at the back of the heel (where the Achilles tendon attaches). This can injure the heel and cause Sever's disease.
Causes
Apart from the age of the young person, other factors that may contribute to developing the disease may include; overuse or too much physical activity. Your child?s heel pain may be caused by repeated stress on the heels (running and jumping activities), pressure on the back of the heel from too much standing or wearing poor-fitting shoes. This includes shoes that do not support or provide enough padding for your child?s feet.
Symptoms
Sever?s disease is a clinical diagnosis based on the youth?s presenting symptoms, rather than on diagnostic tests. While x-rays may be ordered in the process of diagnosing the disease, they are used primarily to rule out bone fractures or other bone abnormalities, rather than to confirm the disease. Common Characteristics of Sever?s Disease include Posterior inferior heel pain. Pain is usually absent when waking in the morning. Increased pain with weight bearing, running, or jumping (or activity-related pain). Area often feels stiff or inflexible. Youth may limp at the end of physical activity. Tenderness at the insertion of the tendons. Limited ankle dorsiflexion range that is secondary to tightness of the Achilles tendon. Activity or sport practices on hard surfaces can also contribute to pain, as well as poor quality shoes, worn out shoes, or the wrong shoes for the sport. Typically, the pain from this disease gradually resolves with rest.
Diagnosis
X-rays are normal in Sever's disease, but your doctor will probably get X-rays to rule out other problems. Treatment consists of non-steroidal anti-inflammatory medications and use of a heel lift to relieve tension on the calcaneal apophysis. In more severe cases, phycical therapy consisting of modalities to relieve the pain, and stretching exercises may be helpful. In extreme cases, castings have been used.
Non Surgical Treatment
Heel pain, unlike the heel spurs, that occur in adults is very uncommon in children. Of those children who do get heel pain, by far the most common cause is a disturbance to the growing area at the back of the heel bone (calcaneus) where the strong achilles tendon attaches to it. This is known as Sever's disease or calcaneal apophysitis (inflammation of the growth plate). It is most common between the ages of 10 to 14 years of age. These are one of several different 'osteochondroses' that can occur in other parts of the body, such as at the knee (Osgood-Schlatters Disease).
Prevention
It is important to undertake correct warm ups and warm downs before and after exercise. This should include a stretching routine. It may be necessary to undertake additional stretching outside of sport, especially during stages of growth. Only playing one sport should be avoided. You should not allow your child to play through pain.
Sever's disease occurs in children when the growth plate (which is the growing part of the heel) is injured. The foot is one of the first body parts to grow to full size. This usually occurs in early puberty. During this time, bones often grow faster than muscles and tendons. As a result, muscles and tendons become tight. The heel area is less flexible. During weight-bearing activity (activity performed while standing), the tight heel tendons may put too much pressure at the back of the heel (where the Achilles tendon attaches). This can injure the heel and cause Sever's disease.
Causes
Apart from the age of the young person, other factors that may contribute to developing the disease may include; overuse or too much physical activity. Your child?s heel pain may be caused by repeated stress on the heels (running and jumping activities), pressure on the back of the heel from too much standing or wearing poor-fitting shoes. This includes shoes that do not support or provide enough padding for your child?s feet.
Symptoms
Sever?s disease is a clinical diagnosis based on the youth?s presenting symptoms, rather than on diagnostic tests. While x-rays may be ordered in the process of diagnosing the disease, they are used primarily to rule out bone fractures or other bone abnormalities, rather than to confirm the disease. Common Characteristics of Sever?s Disease include Posterior inferior heel pain. Pain is usually absent when waking in the morning. Increased pain with weight bearing, running, or jumping (or activity-related pain). Area often feels stiff or inflexible. Youth may limp at the end of physical activity. Tenderness at the insertion of the tendons. Limited ankle dorsiflexion range that is secondary to tightness of the Achilles tendon. Activity or sport practices on hard surfaces can also contribute to pain, as well as poor quality shoes, worn out shoes, or the wrong shoes for the sport. Typically, the pain from this disease gradually resolves with rest.
Diagnosis
X-rays are normal in Sever's disease, but your doctor will probably get X-rays to rule out other problems. Treatment consists of non-steroidal anti-inflammatory medications and use of a heel lift to relieve tension on the calcaneal apophysis. In more severe cases, phycical therapy consisting of modalities to relieve the pain, and stretching exercises may be helpful. In extreme cases, castings have been used.
Non Surgical Treatment
Heel pain, unlike the heel spurs, that occur in adults is very uncommon in children. Of those children who do get heel pain, by far the most common cause is a disturbance to the growing area at the back of the heel bone (calcaneus) where the strong achilles tendon attaches to it. This is known as Sever's disease or calcaneal apophysitis (inflammation of the growth plate). It is most common between the ages of 10 to 14 years of age. These are one of several different 'osteochondroses' that can occur in other parts of the body, such as at the knee (Osgood-Schlatters Disease).
Prevention
It is important to undertake correct warm ups and warm downs before and after exercise. This should include a stretching routine. It may be necessary to undertake additional stretching outside of sport, especially during stages of growth. Only playing one sport should be avoided. You should not allow your child to play through pain.
