What Are The Chief Causes Of Calcaneal Apophysitis?

posted on 14 May 2015 22:00 by trashypowder9664
Overview

Sever's disease is a disorder of the growth plate of the calcaneus. Symptoms most often occur at the posterior (back of the heel) aspect of the growth plate but sometimes are experienced at the plantar aspect below the heel. The Achilles tendon attaches to the posterior aspect of the growth plate and the plantar fascia takes part of its origin from the plantar aspect. Sever?s disease occurs more often in boys than girls. The age of onset is usually between 8 to 12 years. Sever?s disease is believed to be caused by overuse. On x-ray the growth center first appears in girls between the ages of 4 to 6 years and boys aged 7 to 8 years. The centers fuse to the primary ossification center of the calcaneus in girls at approximately ages 12 to 14 on boys at ages 15 to 17.

Causes

Sever?s disease is often associated with a growth spurt, when the bones grow but the muscles do not. Therefore the muscles effectively become tighter which results in increased stress at the heel. It may also be related to unusual biomechanics, for instance poor foot posture, muscle tightness or muscle weakness. Overtraining or incorrect training can also play a part. Usually, the cause is a combination of factors.

Symptoms

The main symptom of sever's disease is pain and tenderness at the back of the heel which is made worse with physical activity. Tenderness will be felt especially if you press in or give the back of the heel a squeeze from the sides. There may be a lump over the painful area. Another sign is tight calf muscles resulting with reduced range of motion at the ankle. Pain may go away after a period of rest from sporting activities only to return when the young person goes back to training.

Diagnosis

All medical diagnosis should be made by taking a full history, examining the patient then performing investigations. The problem usually occurs in boys who are going through or have just gone through a growth spurt; one or both heels may be affected. 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. There may be swelling over the back of the heel and this area is painful if touched or knocked. On examination the patient often has flat feet, very tight legs muscles especially the gastrocnemius.

Non Surgical Treatment

Traditional treatment involved simply telling children that they can?t play sport for a year. This is not popular for children or parents and abstaining from sport leads to other problems when wanting to return. Treatments focus on improving foot and lower limb function with footwear selection, heel raises, calf stretching, prescription orthoses, run technique training and training modifications. This results in a reduced load through the growth plate and the child can perform more activity before the growth plate becomes inflamed. Rest will always reduce the Sever?s disease symptoms, however this is always the last option.

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.