What Exactly Is Calcaneal Apophysitis?

Overview

Sever?s disease is a heel problem that is the most common cause of heel pain that commonly occurs in children. It is caused by repetitive use and overuse of the heel while it is still growing, therefore is more common in active children and teenagers. Despite the name, Sever?s Disease like Osgood- Schlatter disease is caused by overuse and is not a disease.

Causes

Sever's disease can result from standing too long, which puts constant pressure on the heel. Poor-fitting shoes can contribute to the condition by not providing enough support or padding for the feet or by rubbing against the back of the heel. Although Sever's disease can occur in any child, these conditions increase the chances of it happening. Pronated foot (a foot that rolls in at the ankle when walking), which causes tightness and twisting of the Achilles tendon, thus increasing its pull on the heel's growth plate. Flat or high arch, which affects the angle of the heel within the foot, causing tightness and shortening of the Achilles tendon. Short leg syndrome (one leg is shorter than the other), which causes the foot on the short leg to bend downward to reach the ground, pulling on the Achilles tendon. Overweight or obesity, which puts weight-related pressure on the growth plate.

Symptoms

Athletes with Sever?s disease are typically aged 9 to 13 years and participate in running or jumping sports such as soccer, football, basketball, baseball, and gymnastics. The typical complaint is heel pain that develops slowly and occurs with activity. The pain is usually described like a bruise. There is rarely swelling or visible bruising. The pain is usually worse with running in cleats or shoes that have limited heel lift, cushion, and arch support. The pain usually goes away with rest and rarely occurs with low-impact sports such as bicycling, skating, or swimming.

Diagnosis

A doctor or other health professional such as a physiotherapist can diagnose Sever?s disease by asking the young person to describe their symptoms and by conducting a physical examination. In some instances, an x-ray may be necessary to rule out other causes of heel pain, such as heel fractures. Sever?s disease does not show on an x-ray because the damage is in the cartilage.

Non Surgical Treatment

Management consists of explanation of what's happening and advice on activity modification to get it to settle. Icing after activity and heating during breaks in activity also often help. Local treatment with electrotherapy may be indicated in the acute stage or to help settle pain for a specific activity/competition. Stretches will be advised and the child may require orthotics to control foot position. A heel raise or heel cups may also help. Strapping may be of some benefit. The mainstay of treatment however is the icing and activity modification and reassurance that the condition is self-limiting, this may take up to 2 years.

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. Finally, LISTEN To Your Child! If your child is suffering heel pain between the ages of 8 to 12, suspect Sever's disease until proven otherwise. Seek the professional opinion of your foot practitioner regarding its diagnosis and subsequent management.

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