Will Calcaneal Apophysitis Require Surgical Procedures?

Overview

Sever?s disease, also known as calcaneal apophysitis, is a common heel problem affecting children. This heel bone disorder is often painful, though it?s usually temporary and causes no long-term health effects. With Sever?s disease, the Achilles tendon repeatedly pulls on the heel?s growth plate, causing microtrauma (i.e. microfractures), inflammation, and swelling in the affected area. Sever?s disease is similar to Osgood-Schlatter disease, which affects the knee. Inappropriate footwear may be a contributing factor in the onset of this condition.

Causes

Apart from the age of the young person, other factors that may contribute to developing the disease may include; overuse or too much physical activity. Your child?s heel pain may be caused by repeated stress on the heels (running and jumping activities), pressure on the back of the heel from too much standing or wearing poor-fitting shoes. This includes shoes that do not support or provide enough padding for your child?s feet.

Symptoms

The most common symptoms of Sever?s involves pain or tenderness in one or both heels. This pain usually occurs at the back of the heel, but can also extend to the sides and bottom of the heel. A child with Sever?s may also have these common problems, Heel pain with limping, especially after running. Difficulty walking, Discomfort or stiffness in the feet upon awaking. Swelling and redness in the heel, Symptoms are usually worse during or after activity and get better with rest.

Diagnosis

This condition is self limiting, it will go away when the two parts of bony growth join together, this is natural. Unfortunately, Sever's disease can be very painful and limit sport activity of the child while waiting for it to go away, so treatment is often advised to help relieve it. In a few cases of Sever's disease, the treatment is not successful and these children will be restricted in their activity levels until the two growth areas join, usually around the age of 16 years. There are no known long term complications associated with Sever's disease.

Non Surgical Treatment

There are several things we can do to treat Sever?s disease and ease the discomfort. Special shoe inserts, such as heel pads or cups, can act as a shock absorber, decrease pressure on the heel bone and slightly elevate the heel to relieve the pain. Elastic wraps and compression stockings can help decrease any swelling and pain. We also show kids some specific stretches that can help stretch the calf muscles and tendons on the back of the leg to reduce stress on the heel. We might also recommend rest, applying ice, elevating the foot, and over-the-counter pain medication.

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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