http://www.advancedfootankle.com I’m Dr. David Laurino and today we’re going to talk about heel pain in children. These are classically referred to as calcaneal apophysitis or Sever’s Disease. So what is calcaneal apophysitis or Sever’s disease? Calcaneal apophysitis is a painful inflammation of the heel’s growth plate. It typically affects children between the ages of 8- and 14-years-old because the heel bone is not fully developed until at least age 14. Until then, new bone is forming at the growth plate, a weak area located at the back of the heel. When there is too much repetitive stress on the growth plate, inflammation can develop. Calcaneal apophysitis
is also called Sever’s Disease, although it is not a true disease. It is the most common cause of heel pain in children and can occur in one or both feet. Heel pain in children differs from the most common type of heel pain in adults. While heel pain in adults usually subsides after a period of walking, pediatric heel pain generally doesn’t improve in this manner. In fact, walking, activity, and sports typically make the pain worse.
So, what causes this? Overuse and stress on the heel bone through participation in sports is a major cause of Calcaneal apophysitis. The heel’s growth plate is sensitive to repeated running and pounding on the hard surfaces, resulting in muscle strain and inflamed tissue. For this reason, children or adolescents involved in soccer, track, volleyball, football, or basketball have especially vulnerable heels. Other causes of Calcaneal apophysitis includes obesity, a tight Achilles tendon, and biomechanical problems such as a flat foot or a high arched foot. Symptoms of Calcaneal Apophysitis may include pain in the back or bottom of the heel, limping, walking on the toes, difficulty running, jumping, or participating in sports, and pain when the sides of the heel are squeezed. To diagnose this condition, a thorough medical history and questions about recent activities is important. Examination of the child’s foot and leg, x-rays, and other advanced imaging studies and laboratory tests may need to be ordered if necessary.
So, how do we treat this condition? Well, our doctors may select one or more of the following options to treat Calcaneal apophysitis. The child needs to reduce or stop the activities that are causing this pain. Support the heel with temporary shoes inserts or preferably custom shoe orthotics to provide support for the heel. Medications such as ibuprofen may help reduce the inflammation. Physical therapy such as RICE, which stands for rest, ice, compression, elevation. Stretching or physical therapy modalities are sometimes used to promote healing of the inflamed tissue. In some severe cases, immobilization may be necessary for pediatric heel pain by using something like an orthopedic walking boot or a cast to promote healing while keeping the foot and angle totally immobile. Often heel pain can return in children because the heel bone is still growing. Reoccurrence of heel pain may be a sign of calcaneal apophysitis or it may indicate a different problem. If your child has repeat bouts of heel pain, be sure to make an appointment.
I get this question a lot from parents: “Can calcaneal apophysitis be prevented?” The chances of a child developing heel pain can be reduced by avoiding obesity, choosing well constructive supportive shoes that are appropriate for the child’s activity, avoiding or limiting wearing of cleated athletic shoes and avoiding activity that is beyond the child’s ability, plus custom molded foot orthotics. Well, I hope you have enjoyed this video. If your child suffers from this condition, contact us for a solution and let us help get your child back on their feet doing the things they love. Please look for more videos on all things foot and ankle on our website and connect with us on social media. Thank you.