Dania Langille

Foot Pain Heel Arch

Addressing Calcaneal Apophysitis

Overview

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.

Causes

Apart from age, other factors that may contribute to developing Sever?s disease include physical activity, any form of exercise that is weight bearing through the legs or stresses the soft tissue can exacerbate the pain of the disease. External factors, for example, running on hard surfaces or wearing inappropriate shoes during sport. Overuse injury, very active children may repeatedly but subtly injure the bones, muscles and tendons of their feet and ankles. In time, the accumulated injuries cause symptoms.

Symptoms

The most prominent symptom of Sever's disease is heel pain which is usually aggravated by physical activity such as walking, running or jumping. The pain is localised to the posterior and plantar side of the heel over the calcaneal apophysis. Sometimes, the pain may be so severe that it may cause limping and interfere with physical performance in sports. External appearance of the heel is almost always normal, and signs of local disease such as edema, erythema (redness) are absent. The main diagnostic tool is pain on medial- lateral compression of the calcaneus in the area of growth plate, so called squeeze test. Foot radiographs are usually normal. Therefore the diagnosis of Sever's disease is primarily clinical.

Diagnosis

Sever condition is diagnosed by detecting the characteristic symptoms and signs above in the older children, particularly boys between 8 and 15 years of age. Sometimes X-ray testing can be helpful as it can occasionally demonstrate irregularity of the calcaneus bone at the point where the Achilles tendon attaches.

Non Surgical Treatment

The initial treatment is rest, relieve the pain and treat the underlying cause. The foot and ankle should be rested so that the apophysis it is not being continually ?injured?. A small heel (sorbothane heel insert) raise can used to raise the heel and take the stretch off the Achilles tendon. It may be sufficient to stop your child playing sport but some children require a short period of bed or couch rest. Some children find resting very difficult and require the use of braces or plasters or boots to slow them down. Using crutches is advised. Severs is usually caused by tight muscles. A stretching program should be followed usually supervised by a physiotherapist. The stretching program may need to be undertaken up to 5 times a day. If flat feet are a problems orthotics (insoles) should be used. The pain should be controlled by rest (limiting activity) and ice (icing the painful area 3-4 times a day - making sure the skin is not burnt), Simple pain killers can be used such as paracetamol as well as anti-inflammatory tablets and cream. Severs disease usually goes away with time. When your child stops growing, the pain and swelling should go away because the growing (weak) area fuses and becomes solid bone which is very strong.

Exercise

Stretching exercises can help. It is important that your child performs exercises to stretch the hamstring and calf muscles, and the tendons on the back of the leg. The child should do these stretches 2 or 3 times a day. Each stretch should be held for about 20 seconds. Both legs should be stretched, even if the pain is only in 1 heel. Your child also needs to do exercises to strengthen the muscles on the front of the shin. To do this, your child should sit on the floor, keeping his or her hurt leg straight. One end of a bungee cord or piece of rubber tubing is hooked around a table leg. The other end is hitched around the child's toes. The child then scoots back just far enough to stretch the cord. Next, the child slowly bends the foot toward his or her body. When the child cannot bend the foot any closer, he or she slowly points the foot in the opposite direction (toward the table). This exercise (15 repetitions of "foot curling") should be done about 3 times. The child should do this exercise routine a few times daily.
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