Calcaneal apophysitis is an inflammation of the heel’s growth plate. It affects children between the ages of 8 and 14 years old, due to the heel bone (calcaneus) not being fully developed until at least age 14. New bone is laying down/forming at the growth plate (physis), which is a weak area located at the back of the heel. When there is repetitive stress on the growth plate, inflammation can develop.
Calcaneal apophysitis is also known as Sever’s disease, This is the most common cause of heel pain in children, and can occur in one or both feet. This heel pain in children is different than the common types of of heel pain experienced by adults.
Overuse/stress on the heel bone through participation in sports is a major contributing factor of calcaneal apophysitis. The growth plate is sensitive to repeated running and pounding on hard surfaces, resulting in inflamed tissue. Children/adolescents involved in cleated sports or hard surface sports are especially vulnerable. Other causes that can contribute to calcaneal apophysitis include obesity, a tight Achilles tendon, and biomechanical problems such as flatfoot or a high-arched foot.
- Pain in the back or bottom of the heel
- Walking on toes to avoid pain at heel
- Difficulty running, jumping, or participating in usual activities or sports
- Pain when the sides of the heel are squeezed
X-rays are ordered to evaluate the heel as well as rule out other bony abnormalities. Other advanced imaging studies and laboratory tests may also be ordered such as an MRI or ultrasound depending on the level of pain.
- Reduce activity. Reduce or stop any activity that causes pain.
- Heel Supports. Custom or over the counter orthotic devices that fit into your shoe help correct the underlying structure of the foot and stabilize and protect the heel.
- Shoe modifications. Wearing supportive shoes that have good arch support and a slightly raised heel reduces stress on the inflammation. At times cleats may need to be discontinued for a period of time to reduce the symptoms
- Ice. Putting an ice pack on your heel for 20 minutes several times a day helps reduce inflammation.
- Medications. Oral nonsteroidal anti-inflammatory drugs (NSAIDs) may be prescribed to reduce pain and inflammation. This will depend on the age of the child.
- Physical therapy. Stretching or physical therapy modalities can be utilized to promote healing of the inflamed issue.
- Immobilization. In some severe cases of pediatric heel pain, a cast or removable boot may be used to promote healing while keeping the foot and ankle immobilized.
Calcaneal apophysitis will usually improve with non surgical treatment modalities and does not require any surgical intervention. Several follow up visits may be necessary to evaluate the progress of improvement.