Therapy For Calcaneal Apophysitis

Overview

Sever?s disease is a common cause of heel pain in children especially in the young and physically active. Severs disease is a painful bone disorder that results from inflammation (swelling) of the growth plate in the heel. A growth plate, also called an epiphyseal plate, is an area at the end of a developing bone where cartilage cells change over time into bone cells. As this occurs, the growth plates expand and unite. It is very important that damage to the growth plate is avoided.

Causes

Overuse and stress on the heel bone through participation in sports is a major cause of calcaneal apophysitis. The heel?s growth plate is sensitive to repeated running and pounding on hard surfaces, resulting in muscle strain and inflamed tissue. For this reason, children and adolescents involved in soccer, track, or basketball are especially vulnerable. Other potential causes of calcaneal apophysitis include obesity, a tight Achilles tendon, and biomechanical problems such as flatfoot or a high-arched foot.

Symptoms

Severs causes swelling, pain and tenderness over the back of the heel. Your child may walk with a limp. Initially the pain may be intermittent occurring only during or after exercise. As the problem gets worse, pain may be present most of the time. The swelling increases and is painful when touched or knocked. It commonly affects boys who are having a growth spurt during their pre-teen or teenage years. One or both knees may be affected.

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

The aims are to reduce trauma to the heel, allow rest/recovery and prevent recurrence. Most cases are successfully treated using physiotherapy and exercises, eg to stretch the gastrocnemius-soleus complex, to mobilise the ankle mortise, subtalar joint and medial forefoot. Soft orthotics or heel cups. Advice on suitable athletic footwear. Other modes of treatment are in severe cases, temporarily limiting activity such as running and jumping. Ice and non-steroidal anti-inflammatory drugs (NSAIDs), which can reduce pain. In very severe cases, a short period of immobilisation (eg 2-3 weeks in a case in mild equinus position) has been suggested.

Prevention

Sever's Disease may be prevented by maintaining good flexibility while the child is growing. The stretching exercises can help lower the risk for injuries during a growth spurt. Having good quality shoes with firm support and a shock-absorbent sole will also help. Child should also avoid excessive running on hard surfaces.

Write a comment

Comments: 0