An update on Calcaneal Apophysitis (Sever’s disease)
Often children between the ages of eight and thirteen attend the podiatry clinic with heel pain. One differential diagnosis is calcaneal apophysitis or otherwise known as sever’s disease. Calcaneal apophysitis is the inflammation of a calcaneal growth plate causing pain in the heel posteriorly, it is classified as a non-articular Osteochondrosis at an impact site (O’Gradaigh & Crisp, 2012).
The calcaneus in a child under sixteen years contains a growth plate posteriorly. This is the section where the Achilles tendon inserts on the calcaneus. Around sixteen years of age, the growth plate ossifies onto the calcaneum. Sever’s disease is the disturbance or micro trauma in…show more content… It is important to note that the condition may be present bilaterally.
Diagnosis is determined on history and clinical symptoms (Goel & Watt, 2002). As X-rays will show the growth plate, the ossification pattern of the calcaneal apophysis varies between patients. Therefore x-rays should not be the only diagnostic tool. It is important to discover if there is calcaneal trauma in the medical history. Pain at the Achilles tendon insertion of the calcaneus and the elimination of differential diagnoses such as Achilles tendinosis, stress fractures, tumor, bone fusion and osteomyelitis usually produce a provisional diagnosis of calcaneal apophysis.
The main pain management strategy consists of conservative measures by restricting the child’s physical activity and reducing the tension stress of the tendon Achilles from repetitive trauma. It also depends on the severity of the condition and the willingness for the child to restrict activities. Immediate relief may be achieved through the application of ice, both when painful and after pain has ceased. Compression and elevation can also be incorporated into the acute management strategy.
It is advisable for the affected foot to be assessed for forefoot/ hindfoot malalignment as it may cause added stress to the insertion of the tendon Achilles (Goel & Watt, 2002). Reducing the traction that may be caused by the tight