ANKLE & FOOT
Is your active adolescents complaining of heel pain during and especially after their sport's team practices? Heel pain in young adolescents, or better known as Calcaneal Apophysitis or Sever's Disease, is a condition we frequently encounter at Ortho Rhode Island. Sever's Disease or Calcaneal Apophysitis is generally defined as inflammation of the secondary growth center in the calcaneus (heel bone apophysis). Calcaneal Apophysitis affects children while bony growth is occurring at the calcaneal epiphysis or growth plate. It is most commonly reported to occur between the ages of 7 and 15 years in boys and 5 and 13 in girls. The average age of presentation in both groups is around 11 years old. The incidence of Calcaneal Apophysitis is reported to be 2 to 16 percent of all musculoskeletal complaints in children.
The predominant theory as to the cause of the condition suggests inflammation occurs at the growth plate (epiphysis) due to repetitive micro-trauma produced by excessive pulling of the Achilles tendon or plantar fascia. A commonly seen predisposing condition for developing Calcaneal Apophysitis is excessive tightness of the Achilles tendon. It has been suggested that when growth spurts or bony elongation is occurring, this may lead to excessive Achilles tendon tightness. The diagnosis of Calcaneal Apophysitis is usually made on the basis of the patient's history and clinical examination. Pain is generally produced on manual compression along the calcaneal (heel) growth plate. X-rays are taken but mainly to rule out other conditions such as avulsion fractures or bone tumors as the cause of heel pain. Radiographs are generally unreliable to make the diagnosis. Symptomatic adolescents typically describe the pain to begin shortly after their sport's activity begins. Their pain tends to progressively worsen as their sport's activities continue.
There are many forms of treatments for Calcaneal Apophysitis. They may include stretching exercises for the tight Achilles tendon or plantar fascia. Heel lifts to physiologically decrease the pulling of the Achilles tendon has also been helpful. Cessation of sports activities for a period of time to immobilization with or without weight-bearing may be prescribed. Physical therapy, ice and nonsteroidal anti-inflammatory drugs are often prescribed. Orthotics may be recommended to address various biomechanical abnormalities if they exist.
In conclusion, if your young athlete or active adolescent is complaining of heel pain at the start of or during their increased activity, most likely they may be suffering from Calcaneal Apophysitis.
