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Pediatric - Severs Disease/Calcaneal Apophysitis (Heel Pain)

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Sever’s disease (also recognized as calcaneal apophysitis, or inflammation of the heel bone growth plate) is one of the most common causes of heel pain in growing children and adolescents. Sever’s disease is caused by repetitive stress to the heel that most often occurs during a child’s growth spurt as the muscles, tendon, and other soft tissue structures begin to change rapidly and become tight. Young patients who participate in athletics are at an increased risk for developing heel pain as the Achilles pulls on the back of the heel growth plate and causes irritation and pain.
Sever’s disease is more commonly observed in young boys, since boys tend to have later growth spurts and may typically develop the heel pain between the ages of 10 and 15. In young girls, the condition usually happens between the ages of 8 and 13.

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Symptoms

Symptoms related to Sever’s disease are similar to those representing an injury of the foot and ankle, that is why it is important to schedule an appointment with a Foot and Ankle specialists. Your child may begin to complain of pain, swelling, or redness in one of both heels. The heel pain usually is worse after running and/or jumping and feels better with ice and rest with the pain particularly worse at the beginning of a sport season or with wearing hard, stiff sole shoes. You may see your child limping during or after physical activity and some patients may walk on their tiptoes to alleviate pressure to the Achilles tendon and heel bone. A classic presentation of Severs disease is tenderness and tightness in the back of the heel that becomes worse when the sides of the heel bone are squeezed.

Examination 

During your appointment, the foot and ankle specialist will examine your child’s foot and ankles and take X-rays to rule out any potential injury to the bone. The doctor will apply pressure to the heel bone on both the sides and the bottom of the bone, which may be tender for a child with Sever’s disease. In addition, the doctor will ask your child to walk, run, jump, squat, or walk in order to determine whether any specific movement elicits painful symptoms. The physician will ask for your child to sit against a strong flat surface and perform small stretching exercises on the patient in order to determine the tightness of specific muscle groups which may be causing the pain to the back of the heels.

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Nonsurgical Treatment:

Conservative (nonsurgical) management is the mainstay for treatment of Sever’s Disease. A child with Sever’sdisease should reduce or even avoid all physical activity until the pain subsides. However, walking and non-bearing exercises, such as swimming and/or riding a bicycle. If you see your child limping and complaining of pain to the back of the foot, along the heel bone, conservative treatment is warranted consisting of placing ice or a cold pack on the heel ever 1-2 hours for 10-15 minutes at a time. This will help limit inflammation to the back of the heel. If the pain is severe, giving your child Ibuprofen (Advil, Motrin, etc.) to subside the pain. Sometimes your doctor will place your child in a CAM walker for short-term immobilization to allow the muscles in the back of the leg and growth plate of the heel bone to calm down. Wearing gel heel cups will protect the heel bone from direct impact and limit the amount of pressure to the back of the heel. However, appropriate daily stretching exercises is the key in treating Sever’s disease and gradually returning to physical activity. Make an appointment with a Foot and Ankle
Specialist for further evaluation.


Surgical Treatment:


Surgical treatment for Sever’s disease is not indicated.

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