Ways To Treat Calcaneal Apophysitis?

Overview

Sever?s Disease is one of the most common overuse injuries affecting children during their secondary growth spurts and is described as a self-limiting condition resolving naturally with skeletal maturity 1. It is suggested to be caused by progressive microtrauma to the bone-cartilage interface in the calcaneal apophysis partly due to large traction forces in the Achilles tendon. The current standard treatment consists mainly of rest, and waiting for skeletal maturity.

Causes

Sever?s is often present at a time of rapid growth in adolescent athletic children. At this time the muscles and tendons become tighter as the bones become larger. Between 8 - 15 years of age is the usual onset of this condition.

Symptoms

The most obvious sign of Sever's disease is pain or tenderness in one or both heels, usually at the back. The pain also might extend to the sides and bottom of the heel, ending near the arch of the foot. A child also may have these related problems, swelling and redness in the heel, difficulty walking, discomfort or stiffness in the feet upon awaking, discomfort when the heel is squeezed on both sides, an unusual walk, such as walking with a limp or on tiptoes to avoid putting pressure on the heel. Symptoms are usually worse during or after activity and get better with rest.

Diagnosis

You may have pain when your doctor squeezes your heel bone. You may have pain when asked to stand or walk on your toes or on your heels. You may have pain in your heel when your doctor stretches your calf muscles. Your doctor may order x-rays of the injured foot to show an active growth plate.

Non Surgical Treatment

Sever?s disease treatment should be based on eliminating pain and restoring normal foot and leg biomechanics. As with most soft tissue injuries the initial treatment is Rest, Ice, and Protect. In the early phase you?ll most likely be unable to walk pain-free. Our first aim is to provide you with some active rest from pain-provoking activities. "No Pain. No Gain." does not apply in Sever's disease. If it hurts your child is doing too much exercise. Your child should reduce or cease any activity that causes heel pain. Ice is a simple and effective modality to reduce your pain and swelling. Please apply for 20-30 minutes each 2 to 4 hours during the initial phase or when you notice that your injury is warm or hot. Most children can tolerate paracetamol as a pain reducing medication. Check with your doctor. To support and protect your heels, you may need to be wear shock absorbing heel cups or a soft orthotic. Kinesio foot taping may help to provide pain relief. Your physiotherapist will guide you and utilise a range of pain relieving techniques including joint mobilisations for stiff ankle or subtalar joints, massage or electrotherapy to assist you during this pain-full phase.

Prevention

Maintain good flexibility through stretching exercises. Avoid excessive running on hard surfaces. Use quality, well-fitting shoes with firm support and a shock-absorbent sole.

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