Every year I see a dozen, or so, young athletes that are having problems when playing. Typically they are running on their toes to avoid heel pressure and play explosive sports with increased heel pressures. Of course these children need to be assessed and properly diagnosed to rule out more severe conditions, but I want to discuss calcaneal apophysitis today as spring begins!
We can often learn a good deal about a particular medical condition if we understand the terminology used in its description. The term, calcaneal, refers to the heel bone while apophysitis describes an inflammation of the heel’s growth center in a child. A calcaneal apophysitis is a condition usually seen in young athletic or physically active children of the age group 8-15. The heel is painful with running or jumping, is usually not swollen visually or discolored, and seems to get progressively worse without treatment. A parent will often bring in a child because of limping during game play along with complaints by the child of discomfort in and around the heel.
Most authorities seem to agree that this condition results from acute or chronic (repetitive) trauma to the heel at a time of vulnerability due to natural growth periods. It should be noted that the heel area of the foot is under normal circumstances, not highly vascularized or well supplied by blood circulation. This means that the area of the foot will heal slower and might be subject to increased risk of injury. Acute trauma refers to a sudden impact or blow to the involved site while repetitive trauma involves cumulative stress over an extended period of time. The bottom line is similar however, with trauma to the growth plate area of the heel being the culprit.
The management of a calcaneal apophysitis condition involves protection and support of the heel in order to allow for normal developmental growth. This can be accomplished by padding the heel of the shoe, wearing protective cups, and in some cases to even further reduce weight-bearing by casting and or crutches. Often I’ll recommend alternating NSAIDs and applying ice before and after activity. The continuance of athletic competition during treatment is an issue that is largely dependent upon how the child responds to therapy initially. In most cases, where the symptoms reduce early on with treatment, the child might continue with physical activity. On the other hand, if the symptoms persist well into the therapy period, then reducing or eliminating continued physical activity might be necessary. This condition in most cases, can be readily managed once identified and properly treated and almost always resolves over time.
