Childrens Foot Care

What Is Calcaneal Apophysitis?

Calcaneal apophysitis is the painful swelling and redness of the heel's growth plate. Children between the ages of 8 to 14 years old are most often affected because the heel bone (calcaneus) continues to develop until at least 14 years of age. Until that age, bone is fusing at the growth plate (physis) and is still vulnerable to repetitive impact. Therefore, the heel bone can become inflamed if excessive stress is applied to the growth plate.

An alternate name for calcaneal apophysitis is Sever's disease, although the condition is not a true "disease." Sever's disease is the leading cause of heel pain in children and may present in one or both feet.

Pediatric heel pain is different from the most common form of heel pain seen in adults. In adults, the level of heel pain usually decreases after walking; but heel pain in children is not relieved in this manner. In fact, pediatric heel pain often worsens after a period of walking.

The leading cause of calcaneal apophysitis is excessive impact and stress on the heel bone when playing sports. Growth plates are still forming in children and adolescents. Repetitive running and impact on hard surface causes muscle strain and inflamed tissue. Therefore, individuals in these age groups who participate in soccer, track and field or basketball are more likely to develop calcaneal apophysitis.

This condition may also result from obesity, a tight Achilles tendon and biomechanical problems including flatfeet or feet with high arches.

Calcaneal apophysitis may be accompanied by the following symptoms:

  • Pain the back or bottom of the heel.
  • Limping.
  • Favoring the toes when walking.
  • Difficulty participating in sports that involve running, jumping or other usual activities.
  • Pain when squeezing the sides of the heel.

Dr. Radovic obtains a complete medical history, asks the patient about recent activitie and examines the affected foot and leg to diagnose the cause of pediatric heel pain, and rule out more serious diagnoses. X-rays, other advanced imaging studies and laboratory exams may be ordered to confirm diagnosis.

Dr. Radovic may choose one or more treatments options for calcaneal apophysitis, including:

  • Reducing or stopping physical activity that causes pain.
  • Wearing temporary shoe inserts or custom orthotic devices to support the heel.
  • Taking ibuprofen or other nonsteroidal anti-inflammatory drugs (NSAIDs) to minimize pain and inflammation.
  • Stretching or rehabilitation exercises to accelerate relief from inflammation.
  • A cast may be used in severe cases of pediatric heel pain to promote healing by completely immobilizing the foot and ankle.

Pediatric heel pain sometimes returns after treatment because the heel bone has not finished growing. Recurrent heel pain sometimes signifies calcaneal apophysitis, but may be a different issue as well. Be sure to schedule an appointment with Dr. Radovic if your child experiences heel pain after the initial treatment.

The likelihood of calcaneal apophysitis may be reduced by:

  • Choosing a well-programmed diet and exercise program to prevent obesity.
  • Choosing supportive shoes that are suitable for the child's activity level.
  • Avoiding or limiting wearing of cleated athletic shoes.
  • Avoiding physical activity that exceeds a child's ability.
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