Cancaneal Apophysitis (Sever’s Disease)
This is the painful inflammation of a child’s growth plate at the heel and causes heel pain. Normally, this affects children between 8 – 14 years old as their calcaneus (heel bone) is still developing. It is also at a time when children often increase the amount of exercise they do. With increased and repetitive use, the achilles tendon ‘tractions’ on the growth plate at the heel causing pain and inflammation. Approximately 60% of Sever’s is bilateral.
It is essentially an overuse injury at the time of growth. Sports that ‘load’ the Achilles tendon and heel, such as running and jumping, are normally the culprits. Often a bout of Sever’s can become aggravated at the start of a season after a ‘rest’ period, or exercising on harder ground as it gets colder. Tightness in the calf can also lead to an increased load on the heel bone. In bad cases, it may take until the child stops growing before complete resolution. Other important areas to look at as to ‘why’ this may have happened, are ankles that do not move well and/or feet that are stiff which result in the force from the ground being poorly dissipated. Also hips that are unable to give the range of movement required can increase the load to the achilles and heel bone, leaving the heels to take the hit! This is key to successful treatment. The symptoms and the diagnosis is Severs Disease, but it is not telling you ‘why’ this is happening.
This needs to be based on a full and correct examination by your osteopath, doctor or other medical professional. An X-ray or MRI scan may be used to confirm the diagnosis or monitor the progress, but often this is not necessary.
Calcaneal apophysitis has no known long-term complications. It is self-limiting in that it should go away when the two parts of bony growth eventually join together (occurring around 16 years of age).
It is important to limit (temporarily) excessive or rigorous activity in its painful stages. It is also about management, as you can get times when it calms and at other times when it can flare up again as they increase activity. Soft shoes and heel cups can make a difference and it is important to make sure the child has sound biomechanics (e.g. no excessive pronation or muscular imbalance). Regular and correct stretching of the tight muscles in the calf and thigh are essential. Ice can be of great help if used correctly. Anti-inflammatory medication may be of use, but do check with your medical professional about this first.
Seeking treatment from your osteopath or good physical therapist can really help too. They will check for poor biomechanics, work and stretch the calf and thigh, and manage this injury with some good strengthening exercises.
Return to sports or activity
The goal here is to get your child back to their desired sport or activity as soon as safely possible. It may be a gradual return to see if the condition regresses. If they return too early, it may lead to more chronic pain.
To return to sport your child should have no pain at rest and should be able to walk pain free. They should also be able to jog, sprint and hop pretty much symptom free as well..
After the pain resolves it is important that there is still a regime of regular stretching of their calves, thigh and leg muscles in place.
If you have any questions or would like us to look at your musculoskeletal problem, please book in to see an osteopath at Back To Back on 020 8605 2323.
If you suffer from an acute muscle injury and are not sure what to do, it is always suggested that you see your GP, Osteopath or Physiotherapist for further assessment and advice on treatment and management.