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Calcaneal Apophysitis Physiotherapy

Overview

Sever?s disease is similar to Osgood-Schlatter disease of the knee in that they both involve a partial detachment or tearing of the tendon from the bone. The difference is location: Osgood-Schlatter occurs at the knee, and Sever?s occurs at the ankle. In Sever?s disease, which usually occurs in children from the ages of 8 to 14, the Achilles tendon begins to tear away from its insertion into the calcaneus or heel bone. This injury can be very painful and affect highly active to somewhat inactive children. Symptoms include pain that increases with activity, localized pain in the back of the foot, tenderness to the touch, and swelling. Treatment includes rest, ice, compression, elevation, and nonsteroidal anti-inflammatory medication as necessary.

Causes

During the growth spurt of early puberty, the bones often grow faster than the leg muscles and tendons. This can cause the muscles to become very tight and overstretched, the heel becomes less flexible and this build-up of pressure can result in redness, swelling, tenderness and pain at the heel.

Symptoms

Sever condition causes pain at the back of the heel. The pain is increased with plantar flexion of the ankle (pushing down with the foot as if stepping on the gas), particularly against resistance. Sever condition also causes tenderness and swelling in the area of the pain.

Diagnosis

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

Cold packs: Apply ice or cold packs to the back of the heels for around 15 minutes after any physical activity, including walking.

Shoe inserts: Small heel inserts worn inside the shoes can take some of the traction pressure off the Achilles tendons. This will only be required in the short term.

Medication: Pain-relieving medication may help in extreme cases, but should always be combined with other treatment and following consultation with your doctor).

Anti-inflammatory creams: Also an effective management tool.

Splinting or casting: In severe cases, it may be necessary to immobilise the lower leg using a splint or cast, but this is rare.

Time: Generally the pain will ease in one to two weeks, although there may be flare-ups from time to time.

Correction of any biomechanical issues: A physiotherapist can identify and discuss any biomechanical issues that may cause or worsen the condition.

Education: Education on how to self-manage the symptoms and flare-ups of Sever?s disease is an essential part of the treatment.

Recovery

One of the most important things to know about Sever's disease is that, with proper care, the condition usually goes away within 2 weeks to 2 months and does not cause any problems later in life. The sooner Sever's disease is addressed, the quicker recovery is. Most kids can return to physical activity without any trouble once the pain and other symptoms go away.
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