Rehab And Calcaneal Apophysitis

Overview

Sever’s disease is a painful irritation in the heel bone of the foot. It is the most common cause of heel pain in children and teens. Sever?s disease is also called calcaneal apophysitis.

Causes

There are several theories surrounding the cause of Sever?s disease. These range from a tight Achilles tendon, to micro stress fractures of the heel, to biomechanical mal-alignment, to trauma, to flat feet, and even to obesity. But the prevailing theory suggests the onset of Sever?s disease occurs when the child’s growth plate is at its weakest, while a tightened Achilles tendon pulls repeatedly on the growth plate, such as during AGS.

Symptoms

The typical patient is a child between 10 and 13 years of age, complaining of pain in one or both heels with running and walking. The pain is localized to the point of the heel where the tendo-achilles inserts into the calcaneus (heel bone), and is tender to deep pressure at that site. Walking on his toes relieves the pain.

Diagnosis

Low-grade inflammation of the calcaneal apophysis cannot be seen on x-ray. Therefore, although x-rays are often done to rule out bony injuries in children with Sever’s disease these x-rays are usually normal. Advanced Sever’s disease can be seen on x-ray but usually the problem is treated before it reaches this point. Other diagnostic tests, such as bone scans or MRI’s, are not usually required in typical cases of Sever’s disease. These, or other tests, may be required to rule out other conditions, such as stress fractures of the calcaneus or other bony abnormalities that can mimic Severs disease.

Non Surgical Treatment

Orthotic insoles are a common form of treatment for Sever?s disease as they provide support and cushioning to the area which reduces the pressure and stress to the area. Our podiatrist can also show your child stretches and exercises to help them manage their pain as well offering them advice on their exercise and activity.

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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