Calcaneal Apophysitis

Calcaneal apophysitis, or Sever’s disease, is frequently reported in the paediatric population, with a higher incidence found in those that are athletic and participate in sports such as football or basketball.

Clinical presentation of Sever’s disease includes posterior heel pain on medial and lateral compression with the prevalence of mild swelling in some cases. Sometimes patients may describe the pain at the heel as being dull or achy, without any noticeable swelling or redness.

The pathophysiology of the condition involves repetitive trauma to the calcaneal apophysis frequently caused by increased traction of the Achilles tendon on its insertion site; this results in inflammation of the apophysis which manifests in the form of heel pain in young children.

Underlying biomechanical disparities such as hyperpronated feet can predispose a child to calcaneal apophysitis by facilitating diminished motion control on the frontal portion of the calcaneus, leading to intense exertion of the calf muscles in achieving heel lift.

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This was further supported in a study conducted by Scharfbillig et al. while investigating risk factors that expedite the onset of Sever’s disease; the authors compared biomechanical foot malalignment between children with the condition and a control group.

The findings of the study revealed disparities in forefoot positioning (the position of the forefoot to the rearfoot) and decreased ankle joint dorsiflexion on the left side of the children affected by calcaneal apophysitis.

This makes it necessary to address biomechanical stressors in comprehensive treatment strategies which should ideally begin with rest and protective weightbearing during initial phases of recovery.

This should be followed by stretching and strengthening exercises to enforce normal ankle dorsiflexion range of motion, stretch out the calf muscles (namely the gastrocnemius and soleus) and to decrease stress on the Achilles tendon.

Orthotic management of calcaneal apophysitis in the form of MASS4D® customised foot orthotics will help in the prevention of hyperpronation which has been identified as one of the more prominent characteristics of patients with Sever’s disease.

This will promote optimal postural alignment to reduce strain on the apophysis, helping protect the child from recurrences in addition to a number of other foot conditions commonly associated with hyperpronation. 

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Related Links
The Various Aetiologies of Heel Pain
Malalignment Syndrome
The Achilles Tendinitis Conundrum 

References:

1. Boutwell, E. (2015) Sever Disease: Intervene Early to Relieve Symptoms. Lower Extremity Review: May 2015. Retrieved from: http://lermagazine.com/
2. Scharfbillig, R. W., Jones, S., Scutter, S. (2011) Sever's Disease: A Prospective Study of Risk Factors. The Journal of the American Podiatric Medical Association: March/April 2011, Vol. 101, No. 2, pp. 133-145.
3. Basra, S. (2011) Practical Pointers On Treating Sever’s Disease In Young Athletes. Podiatry Today: October 2011, Vol. 24, No. 10.

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