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Sever's disease or calcaneal apophysitis

Calcaneal apophysitis is a common cause of heel pain in youth

HEEL PAIN IN YOUTH

Symptoms
Symptoms of Sever's disease or calcaneal apophysitis may include:

  • Pain in the back or bottom of the heel, often after activity
  • Limping
  • Walking on toes
  • Difficulty running, jumping, or participating in usual activities or sports
  • Pain when the sides of the heel are squeezed
  • Sports such as soccer and basketball may aggravate the symptoms

The heel bone or calcaneus is one bone in an adult but forms from two bones during development.  The main part of the heel bone and the area of the heel bone to which the Achilles tendon attached to are the two parts.  A growth plate of softer cartilage like tissue separates the two parts.  A growth plate is termed an "epiphysis" and a growth plate to which a tendon attaches to, an apophysis.  So "calcaneal apophysitis" means inflammation of the growth plate in the heel bone.  "Sever's disease" is another term for calcaneal apophysitis.

 

The calcaneal apophysis gradually disappears as the two parts of the heel bone fuse to become one bone, a process that may occur between the ages of 10 and 14 years of age. The calcaneal apophysis is most sensitive to trauma and most likely to cause pain when over-stressed about 18 to 24 months prior to the time of fusion. 

 

Factors that can stress the calcaneal apophysis include sports that involve a lot of lateral motion such as soccer and basketball, overpronation or inward rolling of the foot, overweight and shoes with inadequate protection for the heel bone.  Soccer shoes, for the most part, are not designed for the immature heel bone, and are often a culprit.

Treatment of calcaneal apophysitis is targeted at eliminating the cause of the problem: 

 

1) Shoes: excessive pronation of the foot may be helped by shoes with proper support, either motion control shoes or stability shoes depending on the level of control required.  Soccer shoes need occasionally be modified with additional heel padding or wedges.

 

2) Orthotics: the term "orthotic" or "foot orthotic" is sometimes used loosely but a true orthotic is a therapeutic device designed to improve function of the foot. Many store bought "orthotics" are little more than cushions or arch supports. The pediatric podiatrist may choose to utilize a high quality prefabricated orthotic, a prefabricated orthotic that is modified or a prescription (custom made) orthotic.

 

What is involved in the making of prescription foot orthotics?

Dr. Larry Huppin of Seattle provides a good overview: http://www.footankle.com/custom-orthotic-production.htm

 

3) Rest:  rest is effective in improving symptoms in the short run but not usually a long term solution. 

 

4) Physical therapy:  a tight heel cord can be a factor in calcaneal apophysitis. Manual therapy is a type of physical therapy that can be very effective for this.