In a child, bones grow from areas called growth plates. The growth plate is made up of cartilage, and is the weakest part of the growing skeleton. Due to their soft nature, these parts of the bone are vulnerable to injury during a child’s development. Therefore, they often fail before the surrounding tissues and ligaments. Consequently, symptoms that may present as tendonitis in adults could present entirely differntly in the young athlete.
Sever’s disease, or calcaneal apophysitis, is the painful irritation and inflammation of the growth plate at the back of the heel. It generally presents in physically active girls and boys ages 8 to 13. The most common complaint is pain at one or both heels, particularly with activities such as running or jumping.
Tight calf muscles are a large risk factor for Sever’s disease. As the taut muscle is pulled across an actively growing bone, tension is created along the growth center causing inflammation and pain to occur.
Sever’s disease, or calcaneal apophysitis, is the painful irritation and inflammation of the growth plate at the back of the heel. It generally presents in physically active girls and boys ages 8 to 13. The most common complaint is pain at one or both heels, particularly with activities such as running or jumping.
Tight calf muscles are a large risk factor for Sever’s disease. As the taut muscle is pulled across an actively growing bone, tension is created along the growth center causing inflammation and pain to occur.
Often, children are placed in a cast, walking boot or heel lifts to help decrease pain occurring at the heel. While this can quickly resolve pain and inflammation surrounding the growth center, if used for extended periods the problem may persist.
Casts, walking boots and heel lifts will place the child’s foot in a neutral position or with the toes pointed down, keeping the calf muscles tight. If these muscles remain tight, inflammation and pain are likely to return as the child returns to normal activity or sport.
To prevent risk of re-injury or returning pain, the child should be placed on a regular stretching regimen to address the muscles involved.
The goal is to return your child to sport or activity as quickly and safely as possible. If the child returns to activities too soon, or continues to play with pain, the injury may worsen.
Severe pain may result in compensatory patterns that put a child at risk for additional injury. This may require a short period of rest from painful activities to decrease pain and inflammation and return normal gait patterns.
Consult your physician or physical therapist regarding when it is safe to return to sport.
The goal is to return your child to sport or activity as quickly and safely as possible. If the child returns to activities too soon or continues to play with pain, the injury may worsen.
Severe pain may result in compensatory patterns that put a child at risk for additional injury. Therefore, a short period of rest from painful activities wil decrease pain and inflammation and return normal gait patterns.
Consult your physician or physical therapist regarding when it is safe to return to sport.
Follow our blog next month to learn about a similar problem that occurs at the knee: Osgood Schlatter Disease.
References:
2. Scharfbillig R. Sever's Disease: What does the literature really tell us. Journal of the Amer Pod Med Assoc. May-June 2008; 212-223.
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