Ann Lieb

Foot Pain In The Arch In The Morning

What Exactly Is Calcaneal Apophysitis?

Overview

Sever?s disease, also known as calcaneal apophysitis, is an inflammation of the heel?s growth plate. It is commonly seen in active children between the ages of 8 and 15 years. These children present with pain when walking, running and jumping. Observable inflammation may or may not be present and parents may often notice their child limping or favouring a limb during or after sports.

Causes

There is no specific known cause of Sever?s disease. However, there are several common factors associated with the condition including. Tight calf muscles. Pronated foot type (rolled in towards the ankle). Children who are heavier. Puberty/growth spurts. External factors, e.g. hard surfaces or poor footwear. Increase in physical activity levels.

Symptoms

Some of the common symptoms of Sever's disease are pain in one or both heels with running and walking. The pain is originates from the point of the heel where the tendo-achilles inserts into the heel bone. Heel pain that goes away when resting. Swollen heel. Calf muscle stiffness first thing in the morning.

Diagnosis

Sever?s disease can be diagnosed based on your history and symptoms. Clinically, your physiotherapist will perform a "squeeze test" and some other tests to confirm the diagnosis. Some children suffer Sever?s disease even though they do less exercise than other. This indicates that it is not just training volume that is at play. Foot and leg biomechanics are a predisposing factor. The main factors thought to predispose a child to Sever?s disease include a decrease in ankle dorsiflexion, abnormal hind foot motion eg overpronation or supination, tight calf muscles, excessive weight-bearing activities eg running.

Non Surgical Treatment

The treatment of Sever's disease depends upon the severity of symptoms experienced by the patient. Care is initiated with a simple program of stretching and heel elevation to weaken the force applied to the calcaneus by the Achilles tendon. If stretches and heel elevation are unsuccessful in controlling the symptoms of Sever's disease, children should be removed from sports and placed on restricted activities. Mild Symptoms. Wear a 3/8 heel lift at all times (not just during physical activity). It is important to use a firm lift and not a soft heel pad. Calf stretches 6/day for 60 seconds each. Calf stretches are best accomplished by standing with the toes on the edge of a stretching block. Moderate Symptoms. Follow the directions for minor symptoms and decrease activity including elimination of any athletic activity. In addition to stretching by day, a night stretching splint can be worn while sleeping. Severe Symptoms. Follow the directions for mild and moderate symptoms. Children should be removed from sports activities such as football, basketball, soccer or gym class. A below knee walking cast with a heel lift or in severe cases, non-weight bearing fiberglass cast, may be indicated for 4-6 weeks. The cast should be applied in a mildly plantar flexed position. Cam Walkers should not be used for Sever's Disease unless they have a built in heel lift.

Prevention

Maintain good flexibility through stretching exercises. Avoid excessive running on hard surfaces. Use quality, well-fitting shoes with firm support and a shock-absorbent sole.
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