Therapy And Calcaneal Apophysitis

posted on 17 May 2015 02:31 by brandy8adams9
Overview

Pain in the heel of a child's foot, typically brought on by some form of injury or trauma, is sometimes Sever's Disease. The disease often mimics Achilles tendonitis, an inflammation of the tendon attached to the back of the heel. A tight Achilles tendon may contribute to Sever's Disease by pulling excessively on the growth plate of the heel bone. This condition is most common in younger children and is frequently seen in the active soccer, football or baseball player. Sport shoes with cleats are also known to aggravate the condition. Treatment includes calf muscle stretching exercises, heel cushions in the shoes, and/or anti-inflammatory medications. Consult your physician before taking any medications.

Causes

A big tendon called the Achilles tendon joins the calf muscle at the back of the leg to the heel. Sever?s disease is thought to occur because of a mismatch in growth of the calf bones to the calf muscle and Achilles tendon. If the bones grow faster than the muscles, the Achilles tendon that attaches the muscle to the heel gets tight. At the same time, until the cartilage of the calcaneum is ossified (turned into bone), it is a potential weak spot. The tight calf muscle and Achilles tendon cause a traction injury on this weak spot, resulting in inflammation and pain. Sever?s disease most commonly affects boys aged ten to 12 years and girls aged nine to 11 years, when growth spurts are beginning. Sever?s disease heals itself with time, so it is known as ?self-limiting?. There is no evidence to suggest that Sever?s disease causes any long-term problems or complications.

Symptoms

Pain in the lower calf and heel area which may be worse when applying pressure either side. Pain worse on activity especially those involving running or jumping. In severe cases this may cause the child to limp when walking. One or both heels affected.

Diagnosis

X-rays are normal in Sever's disease, but your doctor will probably get X-rays to rule out other problems. Treatment consists of non-steroidal anti-inflammatory medications and use of a heel lift to relieve tension on the calcaneal apophysis. In more severe cases, phycical therapy consisting of modalities to relieve the pain, and stretching exercises may be helpful. In extreme cases, castings have been used.

Non Surgical Treatment

Management consists of explanation of what's happening and advice on activity modification to get it to settle. Icing after activity and heating during breaks in activity also often help. Local treatment with electrotherapy may be indicated in the acute stage or to help settle pain for a specific activity/competition. Stretches will be advised and the child may require orthotics to control foot position. A heel raise or heel cups may also help. Strapping may be of some benefit. The mainstay of treatment however is the icing and activity modification and reassurance that the condition is self-limiting, this may take up to 2 years.

Recovery

Receiving the initial diagnosis of Sever?s disease can be scary, and while the situation is painful, there is good news. If treated properly and quickly, Sever?s disease is temporary and will have no long-term effects on the athlete.