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How To Diagnose Calcaneal Apophysitis?

Overview

Sever?s disease (also known as calcaneal apophysitis) is a type of bone injury in which the growth plate in the lower back of the heel, where the Achilles tendon (the heel cord that attaches to the growth plate) attaches, becomes inflamed and causes pain. Sever?s disease is the most common cause of heel pain in children, especially those who exercise or play sports on a regular basis.

Causes

This condition is more common in boys than girls. It generally presents between the ages of 9-14 and peaks between ages 10-12 years. This injury can reoccur up until the age of 17, when the growth plate of the calcaneous generally closes. These types of injuries will commonly occur during periods of rapid growth. Sever?s Disease occurs more frequently in child with flat feet, but all children with flat feet will not get Sever?s.

Symptoms

Most children with Sever’s complain of pain in the heel that occurs during or after activity (typically running or jumping) and is usually relieved by rest. The pain may be worse when wearing cleats. Sixty percent of children’s with Sever’s report experiencing pain in both heels.

Diagnosis

This can include physical examination and x-ray evaluation. X-rays may show some increased density or sclerosis of the apophysis (island of bone on the back of the heel). This problem may be on one side or bilateral.

Non Surgical Treatment

In mild cases, elevating the heel through heel lifts in the shoes and decreasing activity level may be enough to control the pain. In more severe cases, orthotic therapy to help control the motion of the heel, as well as icing, elevating, and aspirin therapy may be required to alleviate the symptoms. In those children who do not respond to either therapy mentioned above, it is sometimes necessary to place the child in a below-knee cast for a period of 4-6 weeks. It is important for both the child and parents to understand that the pain and swelling associated with this disorder should resolve once the growth plate has fused to the primary bone in the heel.

Recovery

It may take several weeks or months for the pain to completely stop. In most cases severs disease goes away on its own with a little rest and time. However if you ignore the pain and play through it, the condition may get worse and may be more difficult to treat. When the pain is completely gone, you can slowly return to your previous level of activity. With future growth spurts the pain may return therefore keep up with the stretches and follow the advice given.

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