Calcaneal apophysitis (Sever's disease) | |
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Other names | Calcaneus apophysitis, Severs |
X-ray of the foot of an 11-year-old child, showing sclerosis and fragmentation of the calcaneal apophysis. This is a sign of low sensitivity and specificity of Sever's disease, because those with Sever's disease may not have it, and this appearance is also present in feet without pain. [1] | |
Specialty | Rheumatology |
Symptoms | in the heel |
Sever's disease, also known as calcaneus apophysitis, is an inflammation at the back of the heel (or calcaneus) growth plate in growing children. The condition is thought to be caused by repetitive stress at the heel. This condition is benign and common and usually resolves when the growth plate has closed or during periods of less activity. It occurs in both males and females. There are a number of locations in the body that may get apophysitis pain. Another common location is at the front of the knee which is known as apophysitis of the tibial tuberosity or Osgood–Schlatter disease.
Children with calcaneal apophysitis commonly complain of pain at the back of the heel. This pain increases with jumping and some running sports. Sometimes, the pain makes children limp and may result in poor sports performance or them not wanting to participate in some sports. The back of the heel is never swollen or red, unless there has been shoe rubbing. When the back of the heel is squeezed from the inside and outside, children with calcaneal apophysitis will report pain. Foot radiographs are not needed to diagnose calcaneal apophysitis as the growth plate can look similar with or without pain. Health professionals should only refer for imaging when the symptoms don't match with the usual presentation or there has been an injury that has resulted in heel pain. Therefore, the diagnosis of Sever's disease is primarily from history and physical assessment. [2]
There are no known causes of calcaneal apophysitis or any ways that it can be prevented. Instead there are things that may contribute to calcaneal apophysitis developing. Children who complain of this type of heel pain commonly are taller (may have just had a growth spurt) or heavier. They also often play sports that have higher jumping, running or direction changes like basketball or soccer. It can also occur more in children who play on hard surfaces. Sometimes children who also start a new sport also complain on this pain or it may happen at the start of a new season. Because calcaneal apophysitis also occurs around puberty, it is thought that it is related to rapid growth and perhaps muscle tightness, [3] [4] but this is not the case for all children. [5] There have been reports that it may also be associated with foot posture (high arches or flat feet). But in large studies, children with calcaneal apophysitis had similar foot postures to children without pain. This means, while some children have high arches or flat feet, not all will get calcaneal apophysitis.
Parents can often use home treatments to resolve pain. Health professionals who also commonly treat this condition are podiatrists, physiotherapists, family medical doctors, paediatricians or orthopaedic surgeons. Treatment may consist of one or more of the following:
Sever's disease is not a serious condition and many children get better without needing health professional care. If use of home treatments like putting ice on the heels or changing sport don't work, children should be assessed by a health professionals to personalise the treatment and make sure it really is calcaneal apophysitis. This condition does not have any long term foot or ankle problems.
While pain from calcaneal apophysitis can go away quickly, it often comes back from time to time. It can appear until children are 12–15 years old.
The correct term for this condition is calcaneal apophysitis. The term Sever's disease was coined after it was first described by James Warren Sever (1878–1964), an American orthopedic doctor, in 1912. [7] Sever published The Principles of Orthopaedic Surgery in 1940 through the Macmillan Company. Sever described it as an apophyseal injury and given it is neither contagious nor progressive, the disease label is being used less with time.[ citation needed ]
The Achilles tendon or heel cord, also known as the calcaneal tendon, is a tendon at the back of the lower leg, and is the thickest in the human body. It serves to attach the plantaris, gastrocnemius (calf) and soleus muscles to the calcaneus (heel) bone. These muscles, acting via the tendon, cause plantar flexion of the foot at the ankle joint, and flexion at the knee.
In humans and many other primates, the calcaneus or heel bone is a bone of the tarsus of the foot which constitutes the heel. In some other animals, it is the point of the hock.
Pes cavus, also known as high arch, is an orthopedic condition that presents as a hollow arch underneath the foot with a pronounced high ridge at the top when weight bearing.
The plantar fascia or plantar aponeurosis is the thick connective tissue aponeurosis which supports the arch on the bottom of the foot. Recent studies suggest that the plantar fascia is actually an aponeurosis rather than true fascia. It runs from the tuberosity of the calcaneus forward to the heads of the metatarsal bones.
Plantar fasciitis or plantar heel pain is a disorder of the plantar fascia, which is the connective tissue that supports the arch of the foot. It results in pain in the heel and bottom of the foot that is usually most severe with the first steps of the day or following a period of rest. Pain is also frequently brought on by bending the foot and toes up towards the shin. The pain typically comes on gradually, and it affects both feet in about one-third of cases.
Genu varum is a varus deformity marked by (outward) bowing at the knee, which means that the lower leg is angled inward (medially) in relation to the thigh's axis, giving the limb overall the appearance of an archer's bow. Usually medial angulation of both lower limb bones is involved.
Achilles tendinitis, also known as Achilles tendinopathy, is soreness the Achilles tendon. It is accompanied by alterations in the tendon's structure and mechanical properties. The most common symptoms are pain and swelling around the back of the ankle. The pain is typically worse at the start of exercise and decreases thereafter. Stiffness of the ankle may also be present. Onset is generally gradual.
Flat feet, also called pes planus or fallen arches, is a postural deformity in which the arches of the foot collapse, with the entire sole of the foot coming into complete or near-complete contact with the ground. Sometimes children are born with flat feet (congenital). There is a functional relationship between the structure of the arch of the foot and the biomechanics of the lower leg. The arch provides an elastic, springy connection between the forefoot and the hind foot so that a majority of the forces incurred during weight bearing on the foot can be dissipated before the force reaches the long bones of the leg and thigh.
Osgood–Schlatter disease (OSD) is inflammation of the patellar ligament at the tibial tuberosity (apophysitis) usually affecting adolescents during growth spurts. It is characterized by a painful bump just below the knee that is worse with activity and better with rest. Episodes of pain typically last a few weeks to months. One or both knees may be affected and flares may recur.
An exostosis, also known as a bone spur, is the formation of new bone on the surface of a bone. Exostoses can cause chronic pain ranging from mild to debilitatingly severe, depending on the shape, size, and location of the lesion. It is most commonly found in places like the ribs, where small bone growths form, but sometimes larger growths can grow on places like the ankles, knees, shoulders, elbows and hips. Very rarely are they on the skull.
Osteochondrosis is a family of orthopedic diseases of the joint that occur in children, adolescents and rapidly growing animals, particularly pigs, horses, dogs, and broiler chickens. They are characterized by interruption of the blood supply of a bone, in particular to the epiphysis, followed by localized bony necrosis, and later, regrowth of the bone. This disorder is defined as a focal disturbance of endochondral ossification and is regarded as having a multifactorial cause, so no one thing accounts for all aspects of this disease.
Tarsal tunnel syndrome (TTS) is a nerve compression syndrome or nerve entrapment syndrome causing a painful foot condition in which the tibial nerve is entrapped as it travels through the tarsal tunnel. The tarsal tunnel is found along the inner leg behind the medial malleolus. The posterior tibial artery, tibial nerve, and tendons of the tibialis posterior, flexor digitorum longus, and flexor hallucis longus muscles travel in a bundle through the tarsal tunnel. Inside the tunnel, the nerve splits into three segments. One nerve (calcaneal) continues to the heel, the other two continue on to the bottom of the foot. The tarsal tunnel is delineated by bone on the inside and the flexor retinaculum on the outside.
A calcaneal spur is a bony outgrowth from the calcaneal tuberosity. Calcaneal spurs are typically detected by x-ray examination. It is a form of exostosis.
Enthesitis is inflammation of the entheses, the sites where tendons, ligaments and joint capsules attach to bones.
A calcaneal fracture is a break of the calcaneus. Symptoms may include pain, bruising, trouble walking, and deformity of the heel. It may be associated with breaks of the hip or back.
Cuboid syndrome or cuboid subluxation describes a condition that results from subtle injury to the calcaneocuboid joint, and ligaments in the vicinity of the cuboid bone, one of seven tarsal bones of the human foot.
Locomotor effects of shoes are the way in which the physical characteristics or components of shoes influence the locomotion neuromechanics of a person. Depending on the characteristics of the shoes, the effects are various, ranging from alteration in balance and posture, muscle activity of different muscles as measured by electromyography (EMG), and the impact force. There are many different types of shoes that exist, such as running, walking, loafers, high heels, sandals, slippers, work boots, dress shoes, and many more. However, a typical shoe will be composed of an insole, midsole, outsole, and heels, if any. In an unshod condition, where one is without any shoes, the locomotor effects are primarily observed in the heel strike patterns and resulting impact forces generated on the ground.
Plantar calcaneal bursitis is a medical condition in which there is inflammation of the plantar calcaneal bursa, a spongy fluid filled sac that cushions the fascia of the heel and the calcaneus. It is characterized by swelling and tenderness of the central plantar heel area. It is sometimes called 'Policeman's heel'. It sometimes was, and should not be, confused with plantar fasciitis, which is inflammation of the plantar fascia and can affect any part of the foot.
Running injuries affect about half of runners annually. The frequencies of various RRI depend on the type of running, such as speed and mileage. Some injuries are acute, caused by sudden overstress, such as side stitch, strains, and sprains. Many of the common injuries that affect runners are chronic, developing over longer periods as the result of overuse. Common overuse injuries include shin splints, stress fractures, Achilles tendinitis, Iliotibial band syndrome, Patellofemoral pain, and plantar fasciitis.
In the skeleton of humans and other animals, a tubercle, tuberosity or apophysis is a protrusion or eminence that serves as an attachment for skeletal muscles. The muscles attach by tendons, where the enthesis is the connective tissue between the tendon and bone. A tuberosity is generally a larger tubercle.
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