What Are The Chief Causes Of Calcaneal Apophysitis?

Overview

Pain in the heel of a child's foot, typically brought on by some form of injury or trauma, is sometimes Sever's Disease. The disease often mimics Achilles tendonitis, an inflammation of the tendon attached to the back of the heel. A tight Achilles tendon may contribute to Sever's Disease by pulling excessively on the growth plate of the heel bone. This condition is most common in younger children and is frequently seen in the active soccer, football or baseball player. Sport shoes with cleats are also known to aggravate the condition. Treatment includes calf muscle stretching exercises, heel cushions in the shoes, and/or anti-inflammatory medications. Consult your physician before taking any medications.

Causes

During the growth spurt of early puberty, the heel bone (also called the calcaneus) sometimes grows faster than the leg muscles and tendons. This can cause the muscles and tendons to become very tight and overstretched, making the heel less flexible and putting pressure on the growth plate. The Achilles tendon (also called the heel cord) is the strongest tendon that attaches to the growth plate in the heel. Over time, repeated stress (force or pressure) on the already tight Achilles tendon damages the growth plate, causing the swelling, tenderness, and pain of Sever's disease. Such stress commonly results from physical activities and sports that involve running and jumping, especially those that take place on hard surfaces, such as track, basketball, soccer, and gymnastics.

Symptoms

Severs causes swelling, pain and tenderness over the back of the heel. Your child may walk with a limp. Initially the pain may be intermittent occurring only during or after exercise. As the problem gets worse, pain may be present most of the time. The swelling increases and is painful when touched or knocked. It commonly affects boys who are having a growth spurt during their pre-teen or teenage years. One or both knees may be affected.

Diagnosis

A Podiatrist can easily evaluate your child?s feet, to identify if a problem exists. Through testing the muscular flexibility. If there is a problem, a treatment plan can be create to address the issue. At the initial treatment to control movement or to support the area we may use temporary padding and strapping and depending on how successful the treatment is, a long-term treatment plan will be arranged. This long-term treatment plan may or may not involve heel raises, foot supports, muscle strengthening and or stretching.

Non Surgical Treatment

When the condition flares, it is treated with activity limitation, medication to reduce inflammation (such as ibuprofen [Advil] or naproxen [Aleve]), shoe inserts, heel lifts, cold packs, and sometimes casting when it becomes especially severe. Sever condition is generally a self-limited problem that usually improves within a year.

Exercise

Stretching exercises can help. It is important that your child performs exercises to stretch the hamstring and calf muscles, and the tendons on the back of the leg. The child should do these stretches 2 or 3 times a day. Each stretch should be held for about 20 seconds. Both legs should be stretched, even if the pain is only in 1 heel. Your child also needs to do exercises to strengthen the muscles on the front of the shin. To do this, your child should sit on the floor, keeping his or her hurt leg straight. One end of a bungee cord or piece of rubber tubing is hooked around a table leg. The other end is hitched around the child's toes. The child then scoots back just far enough to stretch the cord. Next, the child slowly bends the foot toward his or her body. When the child cannot bend the foot any closer, he or she slowly points the foot in the opposite direction (toward the table). This exercise (15 repetitions of "foot curling") should be done about 3 times. The child should do this exercise routine a few times daily.

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