Although heel pain is commonly seen in athletes or older adults, it is certainly not isolated to that segment of the population. In fact, heel pain is quite common in children as well, especially in those that are active.
Of all of the causes of pediatric heel pain, Sever's disease, or calcaneal apophysitis, is the most common cause of childhood heel pain and usually affects children 8-14 years of age. Sever's disease is usually seen in kids that are active and affects males and females alike. Typically, patients experience severe pain in the back of the heel at the insertion of the Achilles tendon on to the calcaneus that significantly limits their ability to play sports and sometimes even to walk.
Sever's disease is medically described as osteochondritis of the calcaneal apophysis. This is an injury to the growth plate which lies between the Achilles tendon insertion and the main body of the calcaneus. All bones in the body start as cartilage and fill in with calcium and other minerals to create a strong skeleton during development. Ossification is the term used to describe this process. The calcaneus or heel bone has two separate areas of ossification that are connected by a cartilaginous growth plate. The Achilles tendon becomes tighter during calf development, causing tension on the growth plate as the patient places the heel on the ground while walking. This trauma is magnified 2-3 times more during vigorous activity such as running or jumping. This then leads to inflammation and pain in the back part of the heel. Over time, simple activities such as running, jumping or even standing can cause severe heel pain. However, with the proper treatment, this condition is easy to resolve.
Treatment usually consists of rest, ice, elevation and a reduction in activity along with biomechanical correction. While it is difficult to keep active children away from their activities, offering them alternatives in a low impact form may help keep them on track during the recovery process. Activities such as swimming, biking, elliptical and roller-skating reduce the tension on the Achilles tendon since they limit the amount of stress placed on the growth plate. Stretching and physical therapy are also extremely important to create length in the Achilles tendon and reduce tension and swelling on the growth plate. Static stretching exercises along with Thera-band exercises and night splints are great ways to lengthen the Achilles tendon while electrical stimulation, ice massage and topical analgesics help with pain and swelling. More extreme cases may require immobilization and possibly Achilles tendon lengthening, although these cases are rare. Lastly, orthotics are vital in pain reduction by addressing inefficient foot function or biomechanics by adding a small heel lift to reduce tension on the growth plate caused by the achilles tendon.
Since Sever's Disease can last up to 18 months, aggressive treatment is recommended as early as possible to reduce down time. If treated early enough, treatment usually lasts 6-8 weeks and patients are usually able to return to their activities at 100% capacity without limitations or recurrence.
Author Resource:-
Dr. Marco A Vargas is a board certified podiatrist who specializes in foot and ankle surgery. For more information on general foot health, get a free copy of his book, "Got Foot Pain?" by visiting his website: http://www.thefootpros.com . He practices in Sugar Land, TX.
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