Calcaneal Apophysitis
What is Calcaneal Apophysitis?
Calcaneal Apophysitis also known as Sever's Disease is a common condition in growing children affecting the growth plate which typically presents as heel pain.
The condition can affect children between the ages of 8-14 and usually starts during a growth spurt.
Growth plates are areas of cartilage located near the ends of bones. Because they are the last portion of a child's bones to harden, growth plates can be vulnerable to injury.
Who is affected by Sever’s disease?
Boys and girls from age 8 to 14 most commonly have Calcaneal Apophysitis. Boys are slightly more likely to develop the condition than girls. Groups with a higher risk of calcaneal apophysitis include children and adolescents who:
- Frequently run and jump, especially on hard surfaces
Participate in high-impact sports, such as netball, AFL, soccer and basketball - Are overweight or obese
- Wear shoes that don’t support their feet or aren’t appropriate for their activities
How long does Calcaneal Apophysitis last?
Calcaneal Apophysitis can last until your child is fully grown. Once the growth plates close, the condition resolves itself.
Symptoms
For children with Calcaneal Apophysitis, the most common symptom is pain in the back of the heel. The pain can cause children to walk on their toes or walk with a limp.
Symptoms may include:
- Pain in one heel or both heels (most children report pain in both heels).
- Tenderness and pain that gets worse with activities (especially jumping and running on hard surfaces) and improves with rest.
- Redness, swelling and irritation in the heels.
Treatment
While it is true that most children will eventually grow out of the condition, many children are forced to stop doing the activities they love due to the pain they experience. Therefore, our focus is to offer the best treatments available.
Below are a general set of treatment guidelines used to treat most patients:
Activity Modification
If possible we try to avoid total rest, particularly in athletic children. If certain types of sporting activities, such as running, are causing moderate to severe pain then we would strongly advise that the child cuts back on activity by at least 50%. Broadly speaking, this may involve reducing the amount of time and/or frequency until symptoms have improved.
Ice
Applying ice for 20 minutes twice daily can be very helpful with pain management and/or acute flare ups after sport.
Footwear
Children should preferably wear a heeled shoe as often as possible. Flat shoes will tend to increase the tension forces on the Achilles Tendon which is more likely to aggravate the growth plate. Therefore, select footwear that has a sufficient heel-to-toe drop (HTTD). The HTTD is the difference between how high the shoe is in the heel and the forefoot. A 10mm HTTD is suitable in most cases.
Also, avoid or minimise barefoot activity on hard surfaces.
Heel lifts
Heel lifts can help further offload the growth plate particularly during sporting activities where the forces acting on the heel are much higher. Depending on the child's needs, we will often prescribe a 4-6mm heel lift which is worn inside their shoe.
Foot Orthotic Therapy
In certain cases, children may benefit from orthotic therapy. Orthoses are only recommended if there is sufficient evidence and a cost-benefit. Most children will benefit from a modified over-the-counter orthotic, however, if we feel that a custom orthotic is more suitable then this will be discussed in detail.