Calcaneal Apophysitis The Facts

Overview

Sever?s disease or Sever?s lesion refers to an injury to the bone growth plate at the back of the heel bone (calcaneous) in young people, particularly those who are physically active. It usually develops in puberty and is slightly more common in boys than girls.

Causes

Sever's disease is a common cause of heel pain in physically active growing kids. It usually occurs during the growth spurt of adolescence, the approximately 2-year period in early puberty when kids grow most rapidly. This growth spurt can begin anytime between the ages of 8 to 13 for girls and 10 to 15 for boys. Peak incidences are girls, 8 to 10 years old. Boys, 10 to 12 years old.

Symptoms

Sever's Disease is most commonly seen in physically active girls and boys from ages 10 to 15 years old. These are the years when the growth plate is still ""open,"" and has not fused into mature bone. Also, these are the years when the growth plate is most vulnerable to overuse injuries, which are usually caused by sports activities. The most common symptoms of this disease include. Heel pain in one or both heels. Usually seen in physically active children, especially at the beginning of a new sports season. The pain is usually experienced at the back of the heel, and includes the following areas. The back of the heel (that area which rubs against the back of the shoe). The sides of the heel. Actually, this is one of the diagnostic tests for Sever's Disease, squeezing the rear portion of the heel from both sides at the same time will produce pain. It is known as the Squeeze Test.

Diagnosis

Sever?s disease is diagnosed based on a doctor?s physical examination of the lower leg, ankle, and foot. If the diagnosis is in question, the doctor may order x-rays or an MRI to determine if there are other injuries that may be causing the heel pain.

Non Surgical Treatment

In general, management is along the normal lines for sports injuries. Simply telling an individual to give up his or her chosen sport is not satisfactory (this may be a very talented young footballer who hopes to become a professional). Explain to the child and parent that this is an overuse injury, common in the growing child. It has a good prognosis but it is necessary to ease back on training for a while to let it recover. Offer to talk to the coach. If the parent and coach are one and the same, beware that the child is being 'pushed' too hard. During abstinence from normal training, cardiovascular fitness can be maintained by non-weight-bearing exercise such as swimming or cycling.

Prevention

Once your child?s growth spurt ends, and she's reached full size, her Sever?s disease won?t return. Until then, the condition can happen again if your child stays very active. Some simple steps can help prevent it. Have your child. Wear supportive, shock-absorbing shoes. Stretch her calves, heels, and hamstrings. Not overdo it. Warn against over-training, and suggest plenty of rest, especially if she begins to feel pain in her heel. Try to avoid lots of running and pounding on hard surfaces. If she?s overweight, help her lose those extra pounds, which can increase pressure on her heels.

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