What Causes Calcaneal Apophysitis?

Overview

Sever's disease is a disorder that commonly occurs in active children between the ages of 9 and 13 years of age. Even though it is misnamed as a disease, it is actually a self-limiting disorder that occurs around the growth plate in the back of the heel. The Achilles tendon attaches to the upper portion of the heel growth plate. On the bottom of the growth plate is an attachment of a ligament known as the plantar fascia. With increased activity, there is a pulling or tugging that occurs on this growth plate, and a portion of the growth plate is being pulled away from its attachment to the heel. X-rays are often taken to verify the position and location of this growth plate.

Causes

Sever?s is often present at a time of rapid growth in adolescent athletic children. At this time the muscles and tendons become tighter as the bones become larger. Between 8 - 15 years of age is the usual onset of this condition.

Symptoms

The most prominent symptom of Sever?s disease is heel pain which is usually aggravated by physical activity such as walking, running or jumping. The pain is localised to the posterior and plantar side of the heel over the calcaneal apophysis. Sometimes, the pain may be so severe that it may cause limping and interfere with physical performance in sports. External appearance of the heel is almost always normal, and signs of local disease such as edema, erythema (redness) are absent. The main diagnostic tool is pain on medial- lateral compression of the calcaneus in the area of growth plate, so called squeeze test. Foot radiographs are usually normal. Therefore the diagnosis of Sever?s disease is primarily clinical.

Diagnosis

This can include physical examination and x-ray evaluation. X-rays may show some increased density or sclerosis of the apophysis (island of bone on the back of the heel). This problem may be on one side or bilateral.

Non Surgical Treatment

First, your child should cut down or stop any activity that causes heel pain. Apply ice to the injured heel for 20 minutes 3 times a day. If your child has a high arch, flat feet or bowed legs, your doctor may recommend orthotics, arch supports or heel cups. Your child should never go barefoot. If your child has severe heel pain, medicines such as acetaminophen (one brand name: Tylenol) or ibuprofen (some brand names. Advil, Motrin, Nuprin) may help.

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