Calcaneal Apophysitis Physical Therapy

Overview

Sever's disease is a term used to describe inflammation of the calcaneal apophysis which occurs in children and adolescents. Sever first described the condition in 1912. Further studies have suggested that the condition is due to repeated 'microtrauma' at the site of the attachment of the Achilles tendon to the apophysis of the heel, often as result of sporting activities. The disorder can be classified among the general osteochondrosis syndromes such as Osgood-Schlatter disease.

Causes

At birth, most of our foot bones are still made of cartilage, which ossifies (becomes bony) over the first few years of life. At the back of the heel, there is a growth plate that is attached to the main body of the heel bone by a cartilaginous join. At about the age of 14-15 years, this area of cartilage between the growth plate and the heel bone ossifies, fusing the area to the heel. Sever?s disease occurs when there is too much motion or strain across the growth plate, resulting in this area becoming inflamed and painful.

Symptoms

The most obvious sign of Sever's disease is pain or tenderness in one or both heels, usually at the back. The pain also might extend to the sides and bottom of the heel, ending near the arch of the foot. A child also may have these related problems, swelling and redness in the heel, difficulty walking, discomfort or stiffness in the feet upon awaking, discomfort when the heel is squeezed on both sides, an unusual walk, such as walking with a limp or on tiptoes to avoid putting pressure on the heel. Symptoms are usually worse during or after activity and get better with rest.

Diagnosis

Sever?s disease can be diagnosed based on the symptoms your child has. Your child?s doctor will conduct a physical examination by squeezing different parts of your child?s foot to see if they cause any pain. An X-ray may be used to rule out other problems, such as a broken bone or fracture.

Non Surgical Treatment

The aim of treatment is to reduce the pain and inflammation when gently stretch the muscles. There is likely to be no magic instant cure and the young athlete may have to be patient while they grow. Rest and apply ice or cold therapy to the heel. Do not apply ice directly to the skin but wrap in a wet tea towel to avoid ice burns. Rest from activities which cause pain. If running and playing football makes it worse then reduce or stop this activity and try cycling or swimming to maintain fitness. A temporary measure is to insert a heel pad or heel raise into the shoes. This has the effect of raising the heel and shortening the calf muscles and so taking the strain off the back of the heel. However long term use of a heal raise may shorten the calf muscles when they need stretching. Stretch the calf muscles regularly. Stretching should be done pain free and very gently with this injury. See a sports injury professional who can advise on treatment and rehabilitation.

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. Some orthopedic surgeons will put the affected foot in a cast to immobilize it. However, while the disease does subside quickly, it can recur, for example at the s 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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