Posts sent in: May 2015

Therapy For Calcaneal Apophysitis

21 May 2015 
Overview


Sever?s Disease is one of the most common overuse sports injuries in the U.S. It may not receive the street cred that plantar fasciitis gets, but this painful condition affecting the heel routinely affects child athletes, usually from eight to thirteen years of age, right when the bones are coming together. The pounding force causes inflammation between the bones, according to YNN, as well as injury to the growth plates themselves. While the ?disease? classification may sound scary, it?s actually a quite normal overuse sports injury that does not typically persist into adulthood.


Causes


The cause of Sever's Disease is not entirely clear but it is most likely due to repeated minor trauma that occurs during high-impact activities that involve running and jumping such as soccer, basketball, and gymnastics. It may also occur when an active child regularly wears shoes with poor heel padding, shock absorbency, or poor arch support. Some additional contributing factors are excessive pronation, an overly tight calf muscle, and other flaws in the biomechanics of a child's walking stride. Children who are overweight are also at greater risk of developing Sever's Disease.


Symptoms


Sever?s disease is more common in boys. They tend to have later growth spurts and typically get the condition between the ages of 10 and 15. In girls, it usually happens between 8 and 13. Symptoms can include pain, swelling, or redness in one or both heels, tenderness and tightness in the back of the heel that feels worse when the area is squeezed. Heel pain that gets worse after running or jumping, and feels better after rest. The pain may be especially bad at the beginning of a sports season or when wearing hard, stiff shoes like soccer cleats. Trouble walking. Walking or running with a limp or on tip toes.


Diagnosis


This condition is self limiting, it will go away when the two parts of bony growth join together, this is natural. Unfortunately, Sever's disease can be very painful and limit sport activity of the child while waiting for it to go away, so treatment is often advised to help relieve it. In a few cases of Sever's disease, the treatment is not successful and these children will be restricted in their activity levels until the two growth areas join, usually around the age of 16 years. There are no known long term complications associated with Sever's disease.


Non Surgical Treatment


Management by a health professional of Sever's disease is often wise. There are a few very rare problems that may be causing the pain, so a correct diagnosis is extremely important. Advice should be given on all of what is mentioned above, appropriate activity levels, the use of ice, always wearing shoes, heel raises and stretching, follow this advice. As a pronated foot is common in children with this problem, a discussion regarding the use of foot orthotics long term may be important. Strapping or tape is sometimes used during activity to limit the ankle joint range of motion. If the symptoms are bad enough and not responding to these measures, medication to help with anti-inflammatory may be needed. In some cases the lower limb may need to be put in a cast for 2-6 weeks to give it a good chance to heal. After the calcaneal apophysitis resolves, prevention with the use of stretching, good supportive shock absorbing shoe and heel raises are important to prevent it happening again.


Prevention


To prevent recurrence, patients, parents, coaches, and trainers should be instructed regarding a good preexercise stretching program for the child. Early in the season, encouragement should be given for a preseason conditioning and stretching program. Coaches and trainers should be educated about recognition of the clinical symptoms so they are able to initiate early protective measures and seek medical referral when necessary.
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