How Do I Address Calcaneal Apophysitis In The Home?

posted on 19 May 2015 06:47 by yukikirschman
Overview

Sever disease, first described in 1912, is a painful inflammation of the calcaneal apophysis. It is classified with the child and adolescent nonarticular osteochondroses. (The other disease in this group is Iselin disease, which is inflammation of the base of the fifth metatarsal.) The etiology of pain in Sever disease is believed to be repetitive trauma to the weaker structure of the apophysis, induced by the pull of the tendo calcaneus (Achilles tendon) on its insertion. This results in a clinical picture of heel pain in a growing active child, which worsens with activity. Sever disease is a self-limited condition, accordingly, no known complication exists from failure to make the correct diagnosis.

Causes

Sever?s disease is an osteochondrosis caused by overloading the insertion of the Achilles tendon onto the calcaneus and the apophyseal growth plate in this area. This C-shaped growth zone can become inflamed secondary to repetitive traction stress of the Achilles tendon. Calcaneal apophysitis is a common injury in young athletes and is believed to be caused by running and jumping. Active Children and adolescents (usual age of occurrence 7 to 15 years), particularly during the pubertal growth spurt or at the beginning of a sport season (e.g. gymnasts, basketball and football players), often suffer from this condition. This disease occurs most commonly during the early part of the growth spurt. A boy-to-girl ratio is 2-3:1. None of these causative factors has been tested prospectively and, where tested, none of the measurements has been carried out systematically, and reliability or validity of the measurements has not been considered.

Symptoms

Symptoms include heel pain related to sports activities and worsen after those sport and exercise activities. However, some children who are not in a sport may also get this if they are physically active. If you notice that your child is ?walking on their toes? this is a sign of possible heel pain. The pain is usually on the back of the heel, the sides of the heel, the bottom of the heel, or a combination of all of these. We typically don't see swelling with this, however if pressure is applied to the sides of the heel pain may be reported. Sometimes the pain is so bad the child will have to limp, or take a break from sports activity either for a few days or few months.

Diagnosis

Most often, a healthcare professional can diagnose Sever?s disease by taking a careful history and administering a few simple tests during the physical exam. A practitioner may squeeze the heel on either side; when this move produces pain, it may be a sign of Sever?s disease. The practitioner may also ask the child to stand on their tiptoes, because pain that occurs when standing in this position can also be an indication of Sever?s disease.

Non Surgical Treatment

The immediate goal of treatment is pain relief. Because symptoms generally worsen with activity, the main treatment for Sever's disease is rest, which helps to relieve pressure on the heel bone, decreasing swelling and reducing pain. As directed by the doctor, a child should cut down on or avoid all activities that cause pain until all symptoms are gone, especially running barefoot or on hard surfaces because hard impact on the feet can worsen pain and inflammation. The child might be able to do things that do not put pressure on the heel, such as swimming and biking, but check with a doctor first. The doctor might also recommend that a child with Sever's disease perform foot and leg exercises to stretch and strengthen the leg muscles and tendons, elevate and apply ice (wrapped in a towel, not applied directly to the skin) to the injured heel for 20 minutes two or three times per day, even on days when the pain is not that bad, to help reduce swelling, use an elastic wrap or compression stocking that is designed to help decrease pain and swelling, take an over-the-counter medicine to reduce pain and swelling, such as acetaminophen (Tylenol) or ibuprofen (Advil, Motrin). Children should not be given aspirin for pain due to the risk of a very serious illness called Reye syndrome. In very severe cases, the doctor might recommend that the child wear a cast for anywhere from 2 to 12 weeks to immobilize the foot so that it can heal.

Prevention

Properly stretching to maintain flexibility is effective for preventing Sever's disease. Stretches should target the calves, heel cords, and hamstrings. Your child should do the appropriate stretches two or three times a day, holding the stretch for about 20 seconds each time. Ask your child's doctor for specific exercise instructions. Generally, doctors advise stretching both legs, even if the pain is confined to one heel. It's also helpful to strengthen the shin muscles by having your youngster pull his toes in with a rubber exercise band or a piece of tubing and then stretch them forward. Assist your child in doing 15 repetitions of this exercise, three times a day. Having your child wear shoes with good shock absorbers and avoid running on hard surfaces as much as possible should also help prevent the condition.