What Is Calcaneal Apophysitis? Calcaneal apophysitis is a painful inflammation of the heel?s growth plate. It typically affects children between the ages of 8 and 14 years old, because the heel bone
(calcaneus) is not fully developed until at least age 14. Until then, new bone is forming at the growth plate (physis), a weak area located at the back of the heel. When there is too much repetitive
stress on the growth plate, inflammation can develop. Calcaneal apophysitis is also called Sever?s disease, although it is not a true ?disease.? It is the most common cause of heel pain in children,
and can occur in one or both feet. Heel pain in children differs from the most common type of heel pain experienced by adults. While heel pain in adults usually subsides after a period of walking,
pediatric heel pain generally doesn?t improve in this manner. In fact, walking typically makes the pain worse.
Sever's disease also can result from standing too long, which puts constant pressure on the heel. Poor-fitting shoes can contribute to the condition by not providing enough support or padding for the
feet or by rubbing against the back of the heel. Although Sever's disease can occur in any child, these conditions increase the chances of it happening, pronated foot (a foot that rolls in at the
ankle when walking), which causes tightness and twisting of the Achilles tendon, thus increasing its pull on the heel's growth plate, flat or high arch, which affects the angle of the heel within the
foot, causing tightness and shortening of the Achilles tendon, short leg syndrome (one leg is shorter than the other), which causes the foot on the short leg to bend downward to reach the ground,
pulling on the Achilles tendon, overweight or obesity, which puts weight-related pressure on the growth plate.
Some of the most common signs and symptoms associated with Sever?s disease include. Heel pain or tenderness in one or both heels, usually at the back of the heel. Pain or discomfort upon waking, or
when the heel is squeezed. Heel pain that is worse during or following activity. Limping. Heel swelling or redness. Tight calf muscles. Decreased ankle range of motion.
A physical exam of the heel will show tenderness over the back of the heel but not in the Achilles tendon or plantar fascia. There may be tightness in the calf muscle, which contributes to tension on
the heel. The tendons in the heel get stretched more in patients with flat feet. There is greater impact force on the heels of athletes with a high-arched, rigid foot.
Non Surgical Treatment
Resting the foot and applying ice to the affected area are some of the most effective methods when it comes to treating Sever?s Disease. Make sure the ice is always wrapped in a cloth of some sort.
Applying ice directly to the skin can cause frostbite. A monitored stretching program of the lower limbs (particularly of the calf muscles) as well as a small heel lift may also be suggested.
Sever?s disease is self-recovering, meaning that it will go away on its own when sport is reduced or as the bones mature. The condition is not expected to create any long-term disability, and
expected to subside in 2-8 weeks. However, while the disease does subside quickly, it can recur, for example at the start of a new sports season or during a growth spurt. If your pain does return you
will need to re-introduce the above treatment plan. If the pain persists please seek further advice from your GP.