| Heel
pain is very uncommon in children. Of those children
who do get heel pain, by far the most common cause
is a disturbance to the growing area at the back
of the heel bone (calcaneus) where the strong
achilles tendon attaches to it. This is known
as Sever's
disease
or Calcaneal Apophysitis
(inflammation of the growth plate). It is most
common between the ages of 8 and 14 years of age.
These are one of several different 'osteochondroses'
that can occur in other parts of the body, such
as at the knee (Osgood-Schlatters Disease).
Anatomy
On the posterior aspect of the heel bone (calcaneus)
there is a growth plate which usually starts to
close sometime between 8 and 14 years old. At
around age 14, when growth is nearly complete,
these two bony areas fuse together. Sever's disease
or calcaneal apophysitis is usually considered
to be due to damage or a disturbance in this area
of growth, known as the calcaneal apophysis.
Symptoms:
Pain is usually felt at the back and side of the
heel bone. Sometimes there may be pain at the
bottom of the heel. The pain is usually relieved
when the child is not active and becomes painful
with sport. Squeezing the sides of the heel bone
is often painful. Running and jumping make the
symptoms worse, especially sports involving excessive
shifting or cutting back and forth (i.e. football,
basketball, soccer). One or both heels can be
affected. In more severe cases, the child may
be limping.
Cause:
The cause of Sever's disease is not entirely clear.
It is most likely due to overuse or repeated minor
trauma that happens in a lot of sporting activities
- the growth plate between the two parts of the
heel bone cannot take all the shear stress of
the activities. A tight calf muscle is also common
in those who develop calcaneal apophysitis. A
pronated or flat foot is also more common, due
to uneven weightbearing on the back of the heel
bone. Children who are heavier are also at greater
risk for developing calcaneal apophysitis.
Treatment:
 |
cut
back on sporting activities - don't stop,
just reduce the amount until symptoms improve
(if the condition has been present for a
while, a total break from sport may be needed
later) |
|
avoid going barefoot |
|
an
arch support and soft cushioned heel raise
is important (this reduces the pull from
the calf muscles on the growth plate and
increases the shock absorption, so the growth
plate is not knocked around as much). |
|
stretch
the calf muscles, (provided the stretch
does not cause pain in the area of the growth
plate) |
|
the use of an ice pack after activity for
20mins is often useful for calcaneal apophysitis
- this should be repeated 2 to 3 times a
day. |
| |
|
If the
symptoms are bad enough, anti-inflammatory medications
may be needed. In rare instances, the lower limb
may need to be put in a cast for 2-6 weeks to
give it a good chance to heal.
After
the calcaneal apophysitis resolves, prevention
with the use of stretching, good supportive shock
absorbing shoe and arch supports with heel raises
are important to prevent it happening again. A
custom-molded orthotic device may be fabricated
by your doctor.
Long-Term Consequences:
This condition is self limiting - it will go away
when the two parts of bony growth join together.
Fortunately, there are no known long term complications
associated with calcaneal apophysitis, even with
the most severe of cases.
The
doctors at Michigan Foot
and Ankle Center are well-trained in
identifying this problem and are usually able
to create a solution which will allow the child
to continue participating in sports. |
