Earleen Wilkerson
That which does not kill us makes us stronger.
Calcaneal Apophysitis Therapy
Overview


One of the more common limitations to children enjoying their youthful energy is Sever?s Disease. Sever?s Disease is a pathology that affects the heels of children in their high growth years (usually around 9-15), and it can be quite painful. It usually occurs due to repetitive trauma or impact at the heel. This means that if your child spends a lot of time running around (in sports, or just with friends) the continuous impact of his or her heel to the ground can cause this! Usually, most children will complain of heel pain specifically when they are active; these are considered milder cases. In more severe cases the pain may never cease, whether the child is active or not.


Causes


The heel bone sometimes grows faster than the leg muscles (including the calf muscles) and tendons (including the Achilles tendon) during the early puberty growth spurt. The different growth rate in these structures can cause lower leg muscles and tendons to become overstretched and tight, which makes the heel less flexible and puts excessive pressure on the heel growth plate. The Achilles tendon, the strongest tendon in the body, attaches to the heel growth plate, and repetitive stress on this structure, especially if it?s already tight, can damage the growth plate, leading to tenderness, swelling, and pain. Activities that involve running or jumping, such as soccer, gymnastics, track, and basketball, can place significant stress on a tight Achilles tendon and contribute to the onset of Sever?s disease. Ill-fitting shoes can also contribute to this health problem by failing to provide the right kind of support or by rubbing against the back of heel. The following factors may increase the likelihood of Sever?s disease in kids or young teens. Wearing footwear that is too narrow in the toe box. Leg length inequality. Obesity or carrying excess bodyweight. Excessive foot and ankle pronation.


Symptoms


Severs causes swelling, pain and tenderness over the back of the heel. Your child may walk with a limp. Initially the pain may be intermittent occurring only during or after exercise. As the problem gets worse, pain may be present most of the time. The swelling increases and is painful when touched or knocked. It commonly affects boys who are having a growth spurt during their pre-teen or teenage years. One or both knees may be affected.


Diagnosis


Sever condition is diagnosed by detecting the characteristic symptoms and signs above in the older children, particularly boys between 8 and 15 years of age. Sometimes X-ray testing can be helpful as it can occasionally demonstrate irregularity of the calcaneus bone at the point where the Achilles tendon attaches.


Non Surgical Treatment


Cold packs: Apply ice or cold packs to the back of the heels for around 15 minutes after any physical activity, including walking.


Shoe inserts: Small heel inserts worn inside the shoes can take some of the traction pressure off the Achilles tendons. This will only be required in the short term.


Medication: Pain-relieving medication may help in extreme cases, but should always be combined with other treatment and following consultation with your doctor).


Anti-inflammatory creams: Also an effective management tool.


Splinting or casting: In severe cases, it may be necessary to immobilise the lower leg using a splint or cast, but this is rare.


Time: Generally the pain will ease in one to two weeks, although there may be flare-ups from time to time.


Correction of any biomechanical issues: A physiotherapist can identify and discuss any biomechanical issues that may cause or worsen the condition.


Education: Education on how to self-manage the symptoms and flare-ups of Sever?s disease is an essential part of the treatment.


Recovery


Sever?s disease is self-recovering, meaning that it will go away on its own when the foot is used less or when the bone is through growing. The condition is not expected to create any long-term disability, and expected to subside in 2-8 weeks. The disease may also take several years to stop, because it is often triggered by growing too fast. It is more common in boys, although occurs in girls as well. The average age of symptom onset is 9-11.
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