Calcaneal Apophysitis (Sever's Disease)
Calcaneal apophysitis, also known as Sever’s disease, is the inflammation of the growth plate in the calcaneus (heel bone). The growth plate is an area in the heel bone that allows the bone to grow. This plate is not fully developed until age 14. Therefore, children between the age of 8 to 14 can get inflammation of this area when there is too much repetitive stress.
Causes:
The inflammation of the growth plate is due to overuse and stress of the heel bone. This can be from sports which involve repetitive impact of the heel bone on a hard surface. Sports that are known to cause calcaneal apophysitis include soccer, track & field, and basketball. Also, a tight Achilles tendon, or any biomechanical problem such as flatfoot or high arched foot can attribute to calcaneal apophysitis.
Other risk factors for development of calcaneal apophysitis include the following.
Symptoms:
Symptoms of calcaneal apophysitis in children include pain at the bottom of the heel, limping, walking on toes, difficulty running, and jumping. Patients might complain of the foot being tired easily. Squeezing the side of the heel usually reproduces the pain.
Diagnosis:
History of the condition, with special attention to the type of activity, is important for the diagnosis. Physical examination to reproduce the pain can localize the area of discomfort. X-ray of the heel can be ordered to evaluate the condition and rule out other causes of heel pain.
Treatment:
Once the diagnosis has been made, the following treatments can be implemented.
Calcaneal apophysitis occurs before the closure of the growth plate. Once the growth plate closes, the symptoms should not return.
Calcaneal apophysitis, also known as Sever’s disease, is the inflammation of the growth plate in the calcaneus (heel bone). The growth plate is an area in the heel bone that allows the bone to grow. This plate is not fully developed until age 14. Therefore, children between the age of 8 to 14 can get inflammation of this area when there is too much repetitive stress.
Causes:
The inflammation of the growth plate is due to overuse and stress of the heel bone. This can be from sports which involve repetitive impact of the heel bone on a hard surface. Sports that are known to cause calcaneal apophysitis include soccer, track & field, and basketball. Also, a tight Achilles tendon, or any biomechanical problem such as flatfoot or high arched foot can attribute to calcaneal apophysitis.
Other risk factors for development of calcaneal apophysitis include the following.
- Obesity
- Wearing non supportive shoes
- Wearing cleated athletic shoes
- Participating in activity beyond a child’s ability
Symptoms:
Symptoms of calcaneal apophysitis in children include pain at the bottom of the heel, limping, walking on toes, difficulty running, and jumping. Patients might complain of the foot being tired easily. Squeezing the side of the heel usually reproduces the pain.
Diagnosis:
History of the condition, with special attention to the type of activity, is important for the diagnosis. Physical examination to reproduce the pain can localize the area of discomfort. X-ray of the heel can be ordered to evaluate the condition and rule out other causes of heel pain.
Treatment:
Once the diagnosis has been made, the following treatments can be implemented.
- Reduce activity. Reduce or stop the activity that is causes pain.
- Support the heel. Temporary shoe inserts or custom orthotic devices may provide support for the heel.
- Medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, help reduce the pain and inflammation.
- Physical therapy. Stretching or physical therapy modalities are sometimes used to promote healing of the inflamed issue.
- Immobilization. In some severe cases of pediatric heel pain, a cast may be used to promote healing while keeping the foot and ankle totally immobile.
Calcaneal apophysitis occurs before the closure of the growth plate. Once the growth plate closes, the symptoms should not return.