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CALCANEAL APOPHYSITIS (SEVER’S DISEASE)
Transcript of CALCANEAL APOPHYSITIS (SEVER’S DISEASE)
Poorly cushioned footwear
Tight lower leg muscles, primarily the achilles tendon and the calf
Normal growth pattern when the bones often grow faster than the muscles and tendons CAUSES CALCANEAL APOPHYSITIS
(SEVER’S DISEASE) To diagnose the cause of the child’s heel pain and rule out other more serious conditions, the foot and ankle surgeon obtains a thorough medical history and asks questions about recent activities.
The surgeon will also examine the child’s foot and leg.
X-rays are often used to evaluate the condition. DIAGNOSTIC EXAM Heel pain on one or both sides
Heel pain with running, jumping and other sport related activities
Pain elicited when the heel is squeezed
Walking on toes SIGNS AND SYMPTOMS It typically affects children between the ages of 8 and 14 years old, because the heel bone (calcaneus) is not fully developed until at least age 14.
Calcaneal apophysitis (Sever’s Disease) may last for months.
This condition is usually treated conservatively with stretching and arch supports. The most common cause of heel pain in young athletes.
A painful inflammation of the heel’s calcaneal apophysis growth plate, believed to be caused by repetitive microtrauma from the pull of the Achilles tendon on the apophysis.
It is the most common cause of heel pain in children, and can occur in one or both feet. DEFINITION Lunge Stretch
Begin this exercise with your hands against the wall. Place the leg to be stretched in front of you as demonstrated. Keep your heel down. Gently move your knee forward over your toes until you feel a stretch in the back of your calf or Achilles tendon Hold for 15 seconds and repeat 4 times at a mild to moderate stretch pain-free. EXERCISES
The following exercises are commonly prescribed to patients with Severs disease. You should discuss the suitability of these exercises with your physiotherapist prior to beginning them. Generally, they should be performed 1 - 3 times daily and only provided they do not cause or increase symptoms. icing
exercises addressing any flexibility, strength or balance issues
a gradual return to activity program biomechanical correction
the use of heel wedges
activity modification advice
soft tissue massage
the use of crutches
Physiotherapy treatment is vital for for patients with this condition to reduce pain, allow for increased activity levels and ensure an optimal outcome. Treatment may comprise: obesity,
a tight Achilles tendon, and
biomechanical problems such as flatfoot or a high-arched foot. OTHER POTENTIAL CAUSES inappropriate footwear
poor lower limb biomechanics
poor foot posture
inappropriate training CONTRIBUTING FACTORS Calf Stretch
Begin this exercise with your hands against the wall. Place the leg to be stretched behind you as demonstrated. Keep your heel down, knee straight and feet pointing forwards. Gently lunge forwards until you feel a stretch in the back of your calf, knee or Achilles tendon (figure 3). Hold for 15 seconds and repeat 4 times at a mild to moderate stretch pain-free. Lunge Stretch
(right leg) Calf Stretch
(left leg) Short-leg cast - For recalcitrant symptoms a short-leg cast is occasionally used to force rest the heel and promote healing while keeping the foot and ankle immobile
Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, help reduce the pain and inflammation. OTHER TREATMENT NURSING MANAGEMENT Apply ice when pain is severe
Administer Anti-inflammatory medications such as ibuprofen
Encouraged patient to limit exercise and participate in a different activity
Encouraged using heel cups used in athletic shoes to help relieve stress on the heels
Encourage athletes to perform appropriate stretching exercise during a 20-30 mins warm-up period before each practice or game
Encouraged several weeks of conditioning training before the season begin NURSING DIAGNOSIS Acute Pain
Impaired Physical Mobility
Risk for falls