Diagnosing Calcaneal Apophysitis

Overview

Severs disease, also known as calcaneal apophysitis, is a condition in which the growth plate along the heel becomes inflamed. It most commonly occurs in active, early-teen children. Most patients with Severs disease complain of heel pain. In general the pain is exacerbated with increased activities, such as running, jumping, or climbing stairs. The pain often improves with a period of rest.

Causes

The condition is thought to result from repetitive microtrauma to growth plates of the calcaneus. Although some of the recent articles says, there is no evidence to support that weight and activity levels are risk factors for Sever's disease. High plantar foot pressures are associated with Sever's disease, although it is unclear whether they are a predisposing factor or a result of the condition. Gastrocnemius equinus may be a predisposing factor for Sever's disease.

Symptoms

Symptoms of calcaneal apophysitis may include pain in the back or bottom of the heel, Limping, walking on toes, difficulty running, jumping, or participating in usual activities or sports. Pain when the sides of the heel are squeezed.

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

Ice the heel(s) well after exercise (until the area is cold and numb!) Stretch hamstring and calf muscles 2-3 times daily (exercises below) REST when pain becomes persistent or moderate (even if it means skipping games or practices.) Anti-inflammatory medication such as ibuprofen. If symptoms persist, your child may need to see a physical therapist for additional exercises, and/or an orthopedist for othotics or temporary casting/crutches if pain is severe. Sever?s disease is self-recovering, meaning that it will go away on its own when the heels are rested 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. However, pain can recur, for example at the start of a new sports season, several times if it is not taken care of.

Exercise

The following exercises are commonly prescribed to patients with Severs disease. You should discuss the suitability of these exercises with your physiotherapist prior to beginning them. Generally, they should be performed 1 - 3 times daily and only provided they do not cause or increase symptoms. Your physiotherapist can advise when it is appropriate to begin the initial exercises and eventually progress to the intermediate, advanced and other exercises. As a general rule, addition of exercises or progression to more advanced exercises should take place provided there is no increase in symptoms. Calf Stretch with Towel. Begin this stretch in long sitting with your leg to be stretched in front of you. Your knee and back should be straight and a towel or rigid band placed around your foot as demonstrated. Using your foot, ankle and the towel, bring your toes towards your head as far as you can go without pain and provided you feel no more than a mild to moderate stretch in the back of your calf, Achilles tendon or leg. Hold for 5 seconds and repeat 10 times at a mild to moderate stretch provided the exercise is pain free. Calf Stretch with Towel. Begin this exercise with a resistance band around your foot and your foot and ankle held up towards your head. Slowly move your foot and ankle down against the resistance band as far as possible and comfortable without pain, tightening your calf muscle. Very slowly return back to the starting position. Repeat 10 - 20 times provided the exercise is pain free. Once you can perform 20 repetitions consistently without pain, the exercise can be progressed by gradually increasing the resistance of the band provided there is no increase in symptoms. Bridging. Begin this exercise lying on your back in the position demonstrated. Slowly lift your bottom pushing through your feet, until your knees, hips and shoulders are in a straight line. Tighten your bottom muscles (gluteals) as you do this. Hold for 2 seconds then slowly lower your bottom back down. Repeat 10 times provided the exercise is pain free.

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