What Is Calcaneal Apophysitis?

Overview

Sever?s disease is a condition that occurs in children during the growth spurt of adolescence, typically between the ages of 8 and 13 for girls and 10 and 15 for boys. It is often painful but can be treated early with good results. Sever?s disease occurs when the growth plate in the heel begins to swell. Sever?s disease often occurs during the same period in a child?s growth as Osgood-Schlatter disease.

Causes

This condition most commonly occurs due to repetitive or prolonged activities placing strain on the heel's growth plate, typically during a period of rapid growth. These activities (or sports) usually involve excessive walking, running, jumping or hopping. Severs disease may also be more likely to occur following a poorly rehabilitated sprained ankle, in patients with poor foot biomechanics or those who use inappropriate footwear. In young athletes, this condition is commonly seen in running and jumping sports, such as football, basketball, netball and athletics.

Symptoms

In Sever?s disease, heel pain can be in one or both heels. It usually starts after a child begins a new sports season or a new sport. Your child may walk with a limp. The pain may increase when he or she stands on tiptoe. Your child?s heel may hurt if you squeeze both sides toward the very back. This is called the squeeze test. Your provider may also find that your child?s heel tendons have become tight.

Diagnosis

A doctor can usually tell that a child has Sever's disease based on the symptoms reported. To confirm the diagnosis, the doctor will probably examine the heels and ask about the child's activity level and participation in sports. The doctor might also use the squeeze test, squeezing the back part of the heel from both sides at the same time to see if doing so causes pain. The doctor might also ask the child to stand on tiptoes to see if that position causes pain. Although imaging tests such as X-rays generally are not that helpful in diagnosing Sever's disease, some doctors order them to rule out other problems, such as fractures. Sever's disease cannot be seen on an X-ray.

Non Surgical Treatment

The initial treatment is rest, relieve the pain and treat the underlying cause. The foot and ankle should be rested so that the apophysis it is not being continually ?injured?. A small heel (sorbothane heel insert) raise can used to raise the heel and take the stretch off the Achilles tendon. It may be sufficient to stop your child playing sport but some children require a short period of bed or couch rest. Some children find resting very difficult and require the use of braces or plasters or boots to slow them down. Using crutches is advised. Severs is usually caused by tight muscles. A stretching program should be followed usually supervised by a physiotherapist. The stretching program may need to be undertaken up to 5 times a day. If flat feet are a problems orthotics (insoles) should be used. The pain should be controlled by rest (limiting activity) and ice (icing the painful area 3-4 times a day - making sure the skin is not burnt), Simple pain killers can be used such as paracetamol as well as anti-inflammatory tablets and cream. Severs disease usually goes away with time. When your child stops growing, the pain and swelling should go away because the growing (weak) area fuses and becomes solid bone which is very strong.

Recovery

This condition is self limiting - it will go away when the two parts of bony growth join together - this is natural. Unfortunately, Sever's disease can be very painful and limit sport activity of the child while waiting for it to go away, so treatment is often advised to help relieve it. In a few cases of Sever's disease, the treatment is not successful and these children will be restricted in their activity levels until the two growth areas join - usually around the age of 16 years. There are no known long term complications associated with Sever's disease.

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