Check out this neat recent case that we diagnosed and are treating in the office!
10-year-old male baseball player came in with heel pain. The pain was local on his calcaneus (heel bone). Pain is sharp with certain striking motions.
Patient reports heel pain for about a month. He reports the pain is worse when initially getting moving, but does sometimes feel better after “getting going”. He has not done anything to try to make the pain better because he wants to continue to play baseball and does not want to be side-lined. He also has been essentially playing a sport with back-to-back seasons from August last year through now.
Orthopedic testing for the foot and ankle are negative. Upon gait assessment, it is noted he does not heel strike on the affected leg. Palpable tenderness at the calcaneus. Some tightness in his lower leg musculature (gastrocnemius and soleus). No radicular pain. Achilles insert and plantar fascia palpate normal. No muscular pain involved and no restriction in his range of motion or strength. Reflexes were intact.
Due to the pain being gradual, but worsening and along the calcaneus, X-rays were taken. Upon evaluation and consideration of examination, a diagnosis of Sever’s Disease (aka calcaneal apophysitis) has been given and treatment has begun.
Image courtesy of: Dinesh Brand, Radiopaedia.org, rID: 60324
What is Sever’s Disease?
Sever’s is a common cause of heel pain in growing kids, especially active children. It is inflammation of the growth plate in the heel.
What causes it?
It is commonly caused by repetitive stress on the heel, common with growth spurts and higher impact sports (running, jumping).
What are the symptoms?
Most common symptoms include pain that increases with activity at the heel. Mild swelling may also be noted.
How do we treat it?
Sever’s responds well to emphasizing reducing pain and swelling. Often physical activity is limited until the kid can tolerate activity without pain. If gait is unaffected and not aggravated by participation in athletics, they may continue to participate.
Other treatment includes: reducing inflammation! We like using the cold laser unit. Cushioning the heel or taping to disperse load, anti-inflammatory drugs, and intentional movement that strengthens the muscles in the leg and stretches the calf musculature are also included in treatment. If symptoms and pain do not improve, a “boot” may be required to immobilize the foot to allow healing.
Patients typically respond well with adequate treatment. It is important to assess progress and allow physical activity dependent on toleration and clinical outcomes.
This particular patient is continuing to participate in athletics, but has been instructed to decrease other physical activity otherwise temporarily. He is receiving cold laser treatment daily and kinesiology taping applied until a x-line brace to wear during activity (this will mimic a low dye taping job constantly needing to be re-taped by a professional between games during tournaments). X-rays will be retaken in 4-6 weeks to evaluate progress if symptoms do not resolve or improve.