What Causes Calcaneal Apophysitis?

Overview


Sever's disease involves a lesion to the heel that appears mostly as a result of excessively twisting the ankle. The injury is particularly prevalent in children over 10 and other younger athletes because the heel bone, muscles and tendons are still developing - the bone faster than the muscles - and the condition strikes a growing part of the bone called the calcaneal apophysis. In older people an injury of this sort generally results in a stress fracture.


Causes


Inflammation occurs at the insertion of the achilles tendon into the back of the heel due to a number of reasons. One or several of the following may cause the initiation of Sever?s disease. Rapid growth spurt. Tight calf muscles. Change in footwear (soccer boots / athletic shoes no heel). Excessive rolling in of feet. Poor warm up routine. Remember this condition usually settles as the growth plate fuses within 6-12 months.


Symptoms


Sever?s disease is a clinical diagnosis based on the youth?s presenting symptoms, rather than on diagnostic tests. While x-rays may be ordered in the process of diagnosing the disease, they are used primarily to rule out bone fractures or other bone abnormalities, rather than to confirm the disease. Common Characteristics of Sever?s Disease include Posterior inferior heel pain. Pain is usually absent when waking in the morning. Increased pain with weight bearing, running, or jumping (or activity-related pain). Area often feels stiff or inflexible. Youth may limp at the end of physical activity. Tenderness at the insertion of the tendons. Limited ankle dorsiflexion range that is secondary to tightness of the Achilles tendon. Activity or sport practices on hard surfaces can also contribute to pain, as well as poor quality shoes, worn out shoes, or the wrong shoes for the sport. Typically, the pain from this disease gradually resolves with rest.


Diagnosis


Sever?s disease is diagnosed based on a doctor?s physical examination of the lower leg, ankle, and foot. If the diagnosis is in question, the doctor may order x-rays or an MRI to determine if there are other injuries that may be causing the heel pain.


Non Surgical Treatment


A physiotherapist will assess your pain, presentation and biomechanics. They can then treat your sever?s disease with hands on techniques which may include massage, manual therapy and taping. Your physiotherapist can then provide advice on what you can do at home to further progress your treatment, this may include stretching, strengthening and activity modification. In some cases orthotic prescription may be of benefit.


Recovery


If the child has a pronated foot, a flat or high arch, or another condition that increases the risk of Sever's disease, the doctor might recommend special shoe inserts, called orthotic devices, such as heel pads that cushion the heel as it strikes the ground, heel lifts that reduce strain on the Achilles tendon by raising the heel, arch supports that hold the heel in an ideal position. If a child is overweight or obese, the doctor will probably also recommend weight loss to decrease pressure on the heel. The risk of recurrence goes away on its own when foot growth is complete and the growth plate has fused to the rest of the heel bone, usually around age 15.

tag : Severs Disease,Calcaneal Apophysitis

 
 

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