The calcaneal apophysis is a growth center where the Achilles tendon and the plantar fascia attach to the heel. It first appears in children aged 7 to 8 years. By ages 12 to 14 years the growth center matures and fuses to the heel bone. Injuries can occur from excessive tension on the Achilles tendon and the plantar fascia, or from direct impact on the heel. Excessive stress on this growth center can cause irritation of the heel, also called Sever’s disease.
Symptoms usually arise between ages 9 to 13 in children who are active and participate in running or high impact sports. Heel pain develops slowly and occurs with activity and improves with rest. Some swelling might also be visible.
Exam findings reveal a tender heel with the achilles tendon and plantar fascia usually without pain. Tight achilles tendon contributes to this condition and may be noticed to be tight with restricted motion across the ankle joint. Although this is a clinical diagnosis, X-rays are usually taken to rule out other conditions causing heel pain such as stress fractures which can present similarly.
Treatment entails Rest and Icing the affected area primarily. I usually place my patients in CAM
boot with heel protection. Oftentimes I will prescribe NSAIDs. Achilles tendon stretching exercises are also prescribed. With the above treatment the pain usually subsides and completely disappears once the apophysis has matured.
However, at time heel pain can mimic other conditions that have to be addressed differently. Make an appointment and let us look and see why your child is having pain and limiting there sports participation.