Coping With Calcaneal Apophysitis

posted on 14 May 2015 19:57 by alikefondness8810
Overview

If you?re a young basketballer/netballer/footballer and have heel pain when playing basketball or sports involving running or jumping, you may have a particular growth pain disorder called Sever?s Disease. It is a condition (not a disease) usually affecting 9-15 year olds that occurs at the back of the heel, where the Achilles tendon attaches to the foot. The Achilles tendon is the tendon connected to the calf muscles. Pulling of the calf muscles results in tension in the Achilles and in adolescents, repeated running/jumping can result in pain and inflammation at the heel, this is called Sever?s Disease.

Causes

The heel bone grows faster than the ligaments in the leg. As a result, muscles and tendons can become very tight and overstretched in children who are going through growth spurts. The heel is especially susceptible to injury since the foot is one of the first parts of the body to grow to full size and the heel area is not very flexible. Sever?s disease occurs as a result of repetitive stress on the Achilles tendon. Over time, this constant pressure on the already tight heel cord can damage the growth plate, causing pain and inflammation. Such stress and pressure can result from sports that involve running and jumping on hard surfaces (track, basketball and gymnastics). Standing too long, which puts constant pressure on the heel. Poor-fitting shoes that don?t provide enough support or padding for the feet. Overuse or exercising too much can also cause Sever?s disease.

Symptoms

Chief complaint is heel pain which increases pain during running and jumping activities. Pain is localized to the very posterior aspect of the heel. Pain is elicited only with weightbearing. Mild involvement is present if pain is brought on only with running during sports. The symptoms can be severe, with pain (and possibly limp) with activities of daily living (ie walking).

Diagnosis

To diagnose the cause of the child?s heel pain and rule out other more serious conditions, the foot and ankle surgeon obtains a thorough medical history and asks questions about recent activities. The surgeon will also examine the child?s foot and leg. X-rays are often used to evaluate the condition. Other advanced imaging studies and laboratory tests may also be ordered.

Non Surgical Treatment

A doctor, sports therapist or physiotherapist can apply a plaster cast or boot if the child is in severe pain. This may be worn for a few days or even weeks and should give relief of pain for a while. Carry out a full biomechanical assessment. This may help to determine if any foot biomechanics issues are contributing to the condition. Orthotics or insoles can be prescribed to help correct over pronation or other biomechanics issues. Prescribe anti-inflammatory medication such as ibuprofen to reduce pain and inflammation. This will not be prescribed if asthma the child has asthma. In persistent cases X-rays may be taken but this is not usual. A doctor, sports therapist or physiotherapist will NOT give a steroid injection or operate as these are not suitable treatment options. The condition will usually settle within 6 months, although it can persist for longer.

Prevention

Having Sever?s disease does not predispose children or teens to any other condition, nor is it a permanent problem. It is self-limiting, and when treated, the pain and other symptoms will abate within a few weeks. Once the growth plate has finished growing, Sever?s disease will resolve and won?t recur. It is important to continue to treat any underlying foot conditions and to avoid any long periods of inactivity.

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