Calcaneal Apophysitis Physical Therapy

Overview

The true name of this complaint is calcaneal apophysitis which just means an inflamation of the growth centre of the bone in your heel as a result of pulling by the Achilles tendon - it is important to realise that it is not a disease but rather a condition that develops in the growing skeleton with activity. It is the most common cause of heel pain in young athletes, and is the second most common condition of its kind in the younger athelete after Osgood-Schlatter's disease. It is often seen at a time of rapid growth during which the muscles and soft tissues become tighter as the bones get longer. It occurs more in boys than girls and is seen most commonly between the ages of 8 and 14 years though it tends to be more prevalent in the younger of this group.

Causes

Your child may have pain along the edges of one or both heels during exercise. The pain usually goes away with rest, but may be worse in the morning. Your child's heel may also be slightly swollen and warm. The heel pain may be worse when your child climbs steps or stands on tiptoe. It may cause your child to limp.

Symptoms

Sever condition causes pain at the back of the heel. The pain is increased with plantar flexion of the ankle (pushing down with the foot as if stepping on the gas), particularly against resistance. Sever condition also causes tenderness and swelling in the area of the pain.

Diagnosis

A doctor or other health professional such as a physiotherapist can diagnose Sever?s disease by asking the young person to describe their symptoms and by conducting a physical examination. In some instances, an x-ray may be necessary to rule out other causes of heel pain, such as heel fractures. Sever?s disease does not show on an x-ray because the damage is in the cartilage.

Non Surgical Treatment

Cold packs: Apply ice or cold packs to the back of the heels for around 15 minutes after any physical activity, including walking.

Shoe inserts: Small heel inserts worn inside the shoes can take some of the traction pressure off the Achilles tendons. This will only be required in the short term.

Medication: Pain-relieving medication may help in extreme cases, but should always be combined with other treatment and following consultation with your doctor).

Anti-inflammatory creams: Also an effective management tool.

Splinting or casting: In severe cases, it may be necessary to immobilise the lower leg using a splint or cast, but this is rare.

Time: Generally the pain will ease in one to two weeks, although there may be flare-ups from time to time.

Correction of any biomechanical issues: A physiotherapist can identify and discuss any biomechanical issues that may cause or worsen the condition.

Education: Education on how to self-manage the symptoms and flare-ups of Sever?s disease is an essential part of the treatment.

Exercise

For children with Sever's disease, it is important to habitually perform exercises to stretch the hamstrings, calf muscles, and the tendons on the back of the leg. Stretching should be performed 2-3 times a day. Each stretch should be performed for 20 seconds, and both legs should be stretched, even if the pain is only in one heel. Heel cups or an inner shoe heel lifts are often recommended for patient suffering from Sever's disease. Wearing running shoes with built in heel cups can also decrease the symptoms because they can help soften the impact on the heel when walking, running, or standing.
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