Heel
Pain in Children (Severs Disease; Calcaneal apophysitis) |
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Information
for health professionals on Sever's
disease, calcaneal
apophysitis |
What is
heel pain in children (Severs disease or Calcaneal apophysitis): |
Heel pain, unlike the heel
spurs, that occur in adults is very uncommon in children. Of
those children who do get heel pain, by far the most common cause
is a disturbance to the growing area at the back of the heel
bone (calcaneus) where the strong achilles tendon attaches to it.
This is known as Sever's disease or calcaneal apophysitis (inflammation
of the growth plate). It is most common between the ages of 10 to
14 years of age. These are one of several different 'osteochondroses'
that can occur in other parts of the body, such as at the knee (Osgood-Schlatters
Disease). |
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The anatomy of heel
pain in the child (Severs disease or Calcaneal apophysitis):
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When a baby is born, most of the
bones are still cartilage with only some starting to develop into
bone. When the heel (calcaneus) starts to develop bone, there is
generally one large area of development that starts in the center
of the cartilage heel. This area of bone spreads to 'fill up' the
cartilage. Another area of bone development (ossification) occurs
at the back of the heel bone - see the x-ray to the right. These
two areas of developing bone will have an area of cartilage between
them - this is how the bone grows in size. At around age 16, when
growth is nearly complete, these two bony areas fuse together. Sever's
disease or calcaneal apophysitis is usually considered to be due
to damage or a disturbance in this area of growth. |
The two
growth areas of the calcaneus can be seen on this x-ray. The smaller
area to the back of the heel is normal. Notice the small cartilage
joint between the two. |
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What are
the symptoms of heel pain in the child (Severs disease or Calcaneal
apophysitis): |
Pain is usually felt at the back
and side of the heel bone. Sometimes there may be pain at the bottom
of the heel. The pain is usually relieved when the child is not
active and becomes painful with sport. Squeezing the sides of the
heel bone is often painful. Running and jumping make the symptoms
worse. One or both heels can be affected. In more severe cases,
the child may be limping. |
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What causes
heel pain in children (Severs disease or Calcaneal apophysitis): |
The cause of Sever's
disease is not entirely clear. It is most likely due to overuse
or repeated minor trauma that happens in a lot of sporting activities
- the cartilage join between the two parts of the bone can not
take all the shear stress of the activities. Some children seem
to be just more prone to it for an unknown reason - combine this
with sport, especially if its on a hard surface and the risk of
getting it increases. It can be almost epidemic at the start of
some sports seasons, especially winter. At the start of winter,
the grounds are often harder, but soften later. Children who are
heavier are also at greater risk for developing calcaneal apophysitis.
A tight calf muscle
is also common in those who develop calcaneal apophysitis - if
you look at the x-ray above, you can imagine how much pull there
is from the calf muscles via the achilles tendon on the small
growth plate at the back and the strain that this will place on
the cartilage join between them. A pronated
foot (a foot rolled in at the ankle) is also more common -
it is assumed that this may cause an uneven weight bearing on
the back part of the heel bone.
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Self management
of heel pain in the child (Severs disease or Calcaneal apophysitis): |
If your child
have Sever's disease, the following is suggested:
* cut
back on sporting activities - don't stop, just reduce the amount
until symptoms improve (if the condition has been present for a
while, a total break from sport may be needed later)
* avoid
going barefoot
* a soft
cushioning heel raise is really important (this reduces the pull
from the calf muscles on the growth plate and increases the shock
absorption, so the growth plate is not knocked around as much).
* stretch
the calf muscles, provided the stretch does not cause pain in
the area of the growth plate)
* the
use of an ice pack after activity for 20mins is often useful for
calcaneal apophysitis - this should be repeated 2 to 3 times a day. |
Calf muscle stretch: |
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Podiatric
management of heel pain in children (Severs disease or Calcaneal
apophysitis): |
Management by a health
professional of Sever's disease is often wise. There are a few
very rare problems that may be causing the pain, so a correct
diagnosis is extremely important. Find a
podiatrist here.
Advice should be given
on all of what is mentioned above - appropriate activity levels,
the use of ice, always wearing shoes, heel
raises and stretching
... follow this advice!!!
As a pronated
foot is common in children with this problem, a discussion
regarding the use of foot orthotics
long term may be important.
Strapping or tape is
sometimes used during activity to limit the ankle joint range
of motion.
If the symptoms are
bad enough and not responding to these measures, medication to
help with anti-inflammatory may be needed. In some cases the lower
limb may need to be put in a cast for 2-6 weeks to give it a good
chance to heal.
After the calcaneal
apophysitis resolves, prevention with the use of stretching, good
supportive shock absorbing shoe and heel raises are important
to prevent it happening again.
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What are
the long term consequences of heel pain in the child (Severs disease
or Calcaneal apophysitis): |
This condition is self limiting
- it will go away when the two parts of bony growth join together
- this is natural. Unfortunately, Sever's disease can be very painful
and limit sport activity of the child while waiting for it to go
away, so treatment is often advised to help relieve it. In a few
cases of Sever's disease, the treatment is not successful and these
children will be restricted in their activity levels until the two
growth areas join - usually around the age of 16 years. There are
no known long term complications associated with Sever's disease. |
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Links of
relevance to heel pain in children (Sever's Disease; calcaneal apophysitis) |
Heel
pain in adults
Severs
Disease / Calcaneal apophysitis (ePodiatry's database on pediatric
osetochondroses)
Find
a Podiatrist here
Children's
footwear
Foot
problems in the child
Ask
a question in the foot health forum about heel pain
Footcare
products
Book
on children's walking:
Is
Your Child Walking Right?: Parents Guide to Little Feet |
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ePodiatry
is purely a source of information on heel pain in the child (Sever's
Disease; Calcaneal Apophysitis) andshould at no time be considered
as replacing the expertise of a health professional. We recommend
seeking professional advice for heel pain in children (Severs Disease;
Calcaneal Apophysitis) and any foot problem before embarking on
any form of self treatment or management. Neither the content or
any other service provided through ePodiatry is intended to be relied
on for medical diagnosis or treatment. Do not delay in seeking health
professional advice for heel pain in the child (Sever's Disease;
Calcaneal Apophysitis) or any other foot problem because of something
seen on ePodiatry. |
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©2003.
The information contained on this page about heel pain in the child
(Severs Disease; Calcaneal Apophysitis) is subject to copyright.
No part of the information about heel Pain in children (Severs Disease;
Calcaneal Apophysitis) contained on this page can be reproduced
in any form without the permission of ePodiatry. |
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Heel
Pain in Children (Sever's Disease; Calcaneal apophysitis)
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