Does Calcaneal Apophysitis Often Require Surgical Treatments?

Overview

Severs disease is by far the most common cause of heel pain in young children, the condition commonly occurs in kids around the age of 10-15 years. Severs is a traction apophysitis in which inflammation of the calcaneal apophysis (growth plate) occurs as a result of overuse or micro trauma. As mentioned severs disease is caused by micro trauma and over use, this can include excessive foot pronation (foot rolling in), tight calf muscles, increase in sporting activities and inappropriate footwear. These all put extra sheering forces on the growth plate leading to aggravation and resultant pain. Signs and symptoms of this include pain on squeezing of the heel, absence of swelling and redness, child describing pain as a dull ache, limping and pain with increased activity.

Causes

The heel bone grows faster than the ligaments in the leg. As a result, muscles and tendons can become very tight and overstretched in children who are going through growth spurts. The heel is especially susceptible to injury since the foot is one of the first parts of the body to grow to full size and the heel area is not very flexible. Sever?s disease occurs as a result of repetitive stress on the Achilles tendon. Over time, this constant pressure on the already tight heel cord can damage the growth plate, causing pain and inflammation. Such stress and pressure can result from sports that involve running and jumping on hard surfaces (track, basketball and gymnastics). Standing too long, which puts constant pressure on the heel. Poor-fitting shoes that don?t provide enough support or padding for the feet. Overuse or exercising too much can also cause Sever?s disease.

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

In Sever's disease, heel pain can be in one or both heels. It usually starts after a child begins a new sports season or a new sport. Your child may walk with a limp. The pain may increase when he or she runs or jumps. He or she may have a tendency to tiptoe. Your child's heel may hurt if you squeeze both sides toward the very back. This is called the squeeze test. Your doctor may also find that your child's heel tendons have become tight.

Non Surgical Treatment

The disease can be treated easily and is considered to be temporary, if treated promptly and correctly. If left untreated or if treated improperly, the disease can result in a permanent heel deformity, causing future shoe-fitting difficulties. Other long-term effects can include foot arch problems, potentially resulting in plantar fasciitis or heel spurs and tight calf musculature, which can lead to Achilles tendonitis. The American College of Foot and Ankle Surgeons recommends the following steps, once Sever?s disease has been diagnosed. Reduce or stop any activity that causes pain. Temporary shoe inserts or custom orthotic devices may provide support for the heel. Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may help reduce the pain and inflammation. Stretching and/or physical therapy may be used to promote healing. In severe cases, a cast may be used to keep the foot and ankle immobilized during the healing process.

Recovery

It may take several weeks or months for the pain to completely stop. When the pain is completely gone, your child may slowly return to his or her previous level of activity.

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