What Are The Causes Of Calcaneal Apophysitis?
Overview
If your child is experiencing activity related pain just below the kneecap, at the top of the shinbone, or in their heel or hip then the chances are they are suffering from Osgood Schlatter, Severs disease or Ischial Apophysitis respectively. Today, thousands of children are diagnosed with one of these conditions every year. Many others are never diagnosed and the discomfort is often dismissed as 'growing pains'
Causes
The large calf muscles attach to the heel via a large tendon called the Achilles tendon (See image below). The function of this tendon is to transmit forces produced by the calf muscles to the heel bone. In children, the portion of the heel bone into which the Achilles tendon inserts is separated from the bulk of the heel bone by a growth plate. This growth plate enables bone growth to occur. However, it also represents a site of weakness in the bone. Forcible and repeated contraction of the calf muscles can injure the growth plate. This commonly occurs during a period of rapid growth where the muscles and tendons become tighter as the bones grow. This leads to increased pulling of the calf muscles and Achilles tendon on the heel bone and growth plate.
Symptoms
This syndrome can occur unilaterally or bilaterally. The incidence of bilaterally is approximately 60%. Common signs and symptoms include posterior inferior heel pain (over the medial and lateral surface of the bone). Pain is usually absent when the child gets up in the morning. Increased pain with weight bearing, running or jumping (= activity-related pain). The area often feels stiff. The child may limp at the end of physical activity. Tenderness at the insertion of the tendons (= an avascular necrosis of the arthropathy). Limited ankle dorsiflexion range secondary to tightness of the Achilles tendon. Hard surfaces and poor-quality or worn-out athletic shoes contribute to increased symptoms. The pain gradually resolves with rest. Reliability or validity of methods used to obtain the ankle joint dorsiflexion or biomechanical malalignment data are not commented upon, thus reducing the quality of the data. Although pain and limping are mentioned as symptomatic traits, there have been no attempts to quantify the pain or its effect on the individual.
Diagnosis
Sever disease is most often diagnosed clinically, and radiographic evaluation is believed to be unnecessary by many physicians, but if a diagnosis of calcaneal apophysitis is made without obtaining radiographs, a lesion requiring more aggressive treatment could be missed. Foot radiographs are usually normal and the radiologic identification of calcaneal apophysitis without the absence of clinical information was not reliable.
Non Surgical Treatment
Orthotics or special shoe inserts can also be used to cushion the heel and reduce pain. Physical Therapy. If avoiding physical activities fails to clear up Sever?s disease Genesis Orthopedics & Sports Medicine may proceed with physical therapy. Physical therapy strengthens the muscles and tendons in the heel, releasing pressure and eventually reducing pain.
Prevention
Prevention consists of maintaining good flexibility through stretching exercises, avoid excessive running on hard surfaces, and use quality, well-fitting shoes with firm support and a shock-absorbent sole.
If your child is experiencing activity related pain just below the kneecap, at the top of the shinbone, or in their heel or hip then the chances are they are suffering from Osgood Schlatter, Severs disease or Ischial Apophysitis respectively. Today, thousands of children are diagnosed with one of these conditions every year. Many others are never diagnosed and the discomfort is often dismissed as 'growing pains'
Causes
The large calf muscles attach to the heel via a large tendon called the Achilles tendon (See image below). The function of this tendon is to transmit forces produced by the calf muscles to the heel bone. In children, the portion of the heel bone into which the Achilles tendon inserts is separated from the bulk of the heel bone by a growth plate. This growth plate enables bone growth to occur. However, it also represents a site of weakness in the bone. Forcible and repeated contraction of the calf muscles can injure the growth plate. This commonly occurs during a period of rapid growth where the muscles and tendons become tighter as the bones grow. This leads to increased pulling of the calf muscles and Achilles tendon on the heel bone and growth plate.
Symptoms
This syndrome can occur unilaterally or bilaterally. The incidence of bilaterally is approximately 60%. Common signs and symptoms include posterior inferior heel pain (over the medial and lateral surface of the bone). Pain is usually absent when the child gets up in the morning. Increased pain with weight bearing, running or jumping (= activity-related pain). The area often feels stiff. The child may limp at the end of physical activity. Tenderness at the insertion of the tendons (= an avascular necrosis of the arthropathy). Limited ankle dorsiflexion range secondary to tightness of the Achilles tendon. Hard surfaces and poor-quality or worn-out athletic shoes contribute to increased symptoms. The pain gradually resolves with rest. Reliability or validity of methods used to obtain the ankle joint dorsiflexion or biomechanical malalignment data are not commented upon, thus reducing the quality of the data. Although pain and limping are mentioned as symptomatic traits, there have been no attempts to quantify the pain or its effect on the individual.
Diagnosis
Sever disease is most often diagnosed clinically, and radiographic evaluation is believed to be unnecessary by many physicians, but if a diagnosis of calcaneal apophysitis is made without obtaining radiographs, a lesion requiring more aggressive treatment could be missed. Foot radiographs are usually normal and the radiologic identification of calcaneal apophysitis without the absence of clinical information was not reliable.
Non Surgical Treatment
Orthotics or special shoe inserts can also be used to cushion the heel and reduce pain. Physical Therapy. If avoiding physical activities fails to clear up Sever?s disease Genesis Orthopedics & Sports Medicine may proceed with physical therapy. Physical therapy strengthens the muscles and tendons in the heel, releasing pressure and eventually reducing pain.
Prevention
Prevention consists of maintaining good flexibility through stretching exercises, avoid excessive running on hard surfaces, and use quality, well-fitting shoes with firm support and a shock-absorbent sole.
