What Is Calcaneal Apophysitis? 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
(calcaneus) is not fully developed until at least age 14. Until then, new bone is forming at the growth plate (physis), 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 experienced by 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 typically makes the pain worse.
Apart from age, other factors that may contribute to developing Sever?s disease include physical activity, any form of exercise that is weight bearing through the legs or stresses the soft tissue can
exacerbate the pain of the disease, External factors, for example, running on hard surfaces or wearing inappropriate shoes during sport Overuse injury, very active children may repeatedly but subtly
injure the bones, muscles and tendons of their feet and ankles. In time, the accumulated injuries cause symptoms.
The typical patient is a child between 10 and 13 years of age, complaining of pain in one or both heels with running and walking. The pain is localized to the point of the heel where the
tendo-Achilles inserts into the calcaneus, and is tender to deep pressure at that site. Walking on his toes relieves the pain.
Sever's disease is based on the symptoms reported. To confirm the diagnosis, the clinician will examine the heels and ask about the child's activity level and participation in sports. They may also
squeeze the back part of the heel from both sides at the same time to see if doing so causes pain and also ask the child to stand on tiptoes to see if that position causes pain. There may be
tightness in the calf muscle, which contributes to tension on the heel. Symptoms are usually worse during or after activity and get better with rest. X-rays generally are not that helpful in
diagnosing Sever's disease, but they may be ordered to rule out other problems, such as fractures. Sever's disease cannot be seen on an X-ray.
Non Surgical Treatment
First, your child should cut down or stop any activity that causes heel pain. Apply ice to the injured heel for 25 minutes three times a day. Your child should not go barefoot. If your child has
severe heel pain, ibuprofen (Advil) will help. It is important that your child performs exercises to stretch the hamstring and calf muscles, and the tendons on the back of the leg. The child should
do these stretches five times each, two or three times a day. Each stretch should be held for 20 seconds. Your child also needs to do exercises to strengthen the muscles on the front of the shin. To
do this, have your child stand facing a wall to stretch the calves and the heel cord. Place one foot a shoulder?s width in front of the other, both feet facing the wall. The front knee is bent and
the back knee is straight during the calf stretch. Then have your child push against the wall and feel the stretch in his or her back leg. To stretch out the heel cord, have him or her stay in the
same position and bend the back knee. Repeat three times. Practice this stretch twice daily.
The surgeon may select one or more of the following options to treat calcaneal apophysitis. Reduce activity. The child needs to reduce or stop any activity that causes pain. Support the heel.
Temporary shoe inserts or custom orthotic devices may provide support for the heel. Medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, help reduce the pain and
inflammation. Physical therapy. Stretching or physical therapy modalities are sometimes used to promote healing of the inflamed issue. Immobilization. In some severe cases of pediatric heel pain, a
cast may be used to promote healing while keeping the foot and ankle totally immobile. Often heel pain in children returns after it has been treated because the heel bone is still growing. Recurrence
of heel pain may be a sign of calcaneal apophysitis, or it may indicate a different problem. If your child has a repeat bout of heel pain, be sure to make an appointment with your foot and ankle