Does your child suffer from heel pain?

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 (the calcaneus) is still growing, and does not fully develop until at least the age of 14. Until then, new bone is forming at the growth plate (also known as the physis or epiphyseal 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 more a syndrome. It is the most common cause of heel pain in children and can occur in one or both feet. 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.

Causes of Heel Pain

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 pounding on hard surfaces and pulling from the Achilles tendon and plantar fascia, resulting in strained and inflamed tissue. For this reason, children and adolescents involved in soccer, track, or basketball are especially vulnerable. Other potential causes of calcaneal apophysitis include obesity, a tight Achilles tendon, and biomechanical problems such as flatfoot or a high-arched foot.

Symptoms

• Pain in the back or bottom of the heel

• Limping

• Walking on toes

• Difficulty running, jumping or participating in usual activities or sports

• Pain when the sides of the heel are squeezed

• Tiredness

Diagnosis

To diagnose the cause of the child’s heel pain and rule out other more serious conditions, we obtain a thorough medical history and ask questions about recent activities. We also perform a comprehensive examination and gait analysis. We will take x-rays of both feet to confirm the diagnosis, but mainly to rule out other potential problems such as foreign bodies, fractures, lesions on the bone, etc.

Treatment

• Reduce Activity. The child needs to reduce or stop any activity that causes pain.
• Ice therapy. Cold helps to reduce inflammation which will reduce pain
• Support the heel. Temporary shoe inserts or custom orthotic devices may provide support for the heel by lifting heel to reduce tension of Achilles tendon and lifting and supporting arch to reduce tension of the plantar fascia.
• Medications. Non-steroidal anti-inflammatory medications (NSAIDs), such as ibuprofen, help reduce the inflammation and pain
• Physical therapy. Stretching or physical therapy modalities are sometimes used to promote healing of the inflamed tissue.
• 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. It also guarantees that the child rests the affected limb.