Do I Care For Calcaneal Apophysitis In The Home?

Overview

Sever's disease is a mild traction injury of the heel. There is an apophysitis at the point of the insertion of the Achilles tendon. This condition is treated by raising the heel of the shoe a little, calf-stretching and avoiding strenuous activities for a few weeks.

Causes

The large calf muscles attach to the heel via a large tendon called the Achilles tendon (See image below). The function of this tendon is to transmit forces produced by the calf muscles to the heel bone. In children, the portion of the heel bone into which the Achilles tendon inserts is separated from the bulk of the heel bone by a growth plate. This growth plate enables bone growth to occur. However, it also represents a site of weakness in the bone. Forcible and repeated contraction of the calf muscles can injure the growth plate. This commonly occurs during a period of rapid growth where the muscles and tendons become tighter as the bones grow. This leads to increased pulling of the calf muscles and Achilles tendon on the heel bone and growth plate.

Symptoms

Sever?s is recognized by pain in the back and lower regions of the heel. It usually starts during or immediately following the child's growth spurt, and/or in very active individuals. The child will usually have pain during or following participation in sport, and will often be seen limping off the field or court. Symptoms of Sever's include painful heel, no swelling or warmth, night pain is absent, pain is worse with increased activity, pain which is usually relieved by rest. Children often hobble or limp from the sports field.

Diagnosis

A doctor can usually tell that a child has Sever's disease based on the symptoms reported. To confirm the diagnosis, the doctor will probably examine the heels and ask about the child's activity level and participation in sports. The doctor might also use the squeeze test, squeezing the back part of the heel from both sides at the same time to see if doing so causes pain. The doctor might also ask the child to stand on tiptoes to see if that position causes pain. Although imaging tests such as X-rays generally are not that helpful in diagnosing Sever's disease, some doctors order them to rule out other problems, such as fractures. Sever's disease cannot be seen on an X-ray.

Non Surgical Treatment

Sever?s disease is believed to be the byproduct of repepitive stress and trauma to the growth plate in the calcaneous, or heel bone. The stress is from the pull of the Achilles tendon on the growth plate where the tendon attaches.

Surgical Treatment

The surgeon may select one or more of the following options to treat calcaneal apophysitis. Reduce activity. The child needs to reduce or stop any activity that 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. Often heel pain in children returns after it has been treated because the heel bone is still growing. Recurrence of heel pain may be a sign of calcaneal apophysitis, or it may indicate a different problem. If your child has a repeat bout of heel pain, be sure to make an appointment with your foot and ankle surgeon.

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