Therapy For Calcaneal Apophysitis

Overview

Children with Sever's disease, which is also called calcaneal apophysitis, develop microfractures where the Achilles tendon inserts on the calcaneus, the large bone that makes up the heel of the foot. These microfractures cause pain, which can vary depending on the type of activity your child is doing, and is generally worse after activity and improves with rest. Sever's disease is more common in boys and typically occurs when a child is between 8 and 13 years old. Although it can affect both heels, it more commonly just affects one foot.

Causes

A big tendon called the Achilles tendon joins the calf muscle at the back of the leg to the heel. Sever?s disease is thought to occur because of a mismatch in growth of the calf bones to the calf muscle and Achilles tendon. If the bones grow faster than the muscles, the Achilles tendon that attaches the muscle to the heel gets tight. At the same time, until the cartilage of the calcaneum is ossified (turned into bone), it is a potential weak spot. The tight calf muscle and Achilles tendon cause a traction injury on this weak spot, resulting in inflammation and pain. Sever?s disease most commonly affects boys aged ten to 12 years and girls aged nine to 11 years, when growth spurts are beginning. Sever?s disease heals itself with time, so it is known as ?self-limiting?. There is no evidence to suggest that Sever?s disease causes any long-term problems or complications.

Symptoms

As a parent, you may notice your child limping while walking or running awkwardly. If you ask them to rise onto their tip toes, their heel pain usually increases. Heel pain can be felt in one or both heels in Sever's disease.

Diagnosis

Most often, a healthcare professional can diagnose Sever?s disease by taking a careful history and administering a few simple tests during the physical exam. A practitioner may squeeze the heel on either side; when this move produces pain, it may be a sign of Sever?s disease. The practitioner may also ask the child to stand on their tiptoes, because pain that occurs when standing in this position can also be an indication of Sever?s disease.

Non Surgical Treatment

The treatment of Sever's disease depends upon the severity of symptoms experienced by the patient. Care is initiated with a simple program of stretching and heel elevation to weaken the force applied to the calcaneus by the Achilles tendon. If stretches and heel elevation are unsuccessful in controlling the symptoms of Sever's disease, children should be removed from sports and placed on restricted activities. Mild Symptoms. Wear a 3/8 heel lift at all times (not just during physical activity). It is important to use a firm lift and not a soft heel pad. Calf stretches 6/day for 60 seconds each. Calf stretches are best accomplished by standing with the toes on the edge of a stretching block. Moderate Symptoms. Follow the directions for minor symptoms and decrease activity including elimination of any athletic activity. In addition to stretching by day, a night stretching splint can be worn while sleeping. Severe Symptoms. Follow the directions for mild and moderate symptoms. Children should be removed from sports activities such as football, basketball, soccer or gym class. A below knee walking cast with a heel lift or in severe cases, non-weight bearing fiberglass cast, may be indicated for 4-6 weeks. The cast should be applied in a mildly plantar flexed position. Cam Walkers should not be used for Sever's Disease unless they have a built in heel lift.

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