Calcaneal apophysitis

definition

The Calcane apophysitisi denotes a disease of Heel bone, which is also called the calcaneus. Above all, she joins Children between the ages of 8 and 16 that are in the growth phase at this time.

You can find out more about the topic here: Growing pains

An increased mechanical load can soften the Apophysis (Starting point for tendons and ligaments on the bone) of the calcaneus. The attachment of the Achilles tendon, which is located on the heel bone, can also be inflamed. Often the disease appears on both sides at the same time and manifests itself in heel pain. Boys are more often affected than girls.

Duration

The calcaneal apophysitis occurs mainly in the Children and adolescents on, since during this period the growth a reduced resilience of the affected structures causes. By protecting the heel, the pain usually subsides quickly, then you just have to be careful not to end the break too early in order to prevent it from recurring in the near future. A break from 4-6 weeks is therefore recommended.

As a general rule heals calcaneal apophysitis without consequences and at the latest by the end of the growth phase there are no more complaints.

In very rare cases, continued stress on the heel can result in a Change in the attachment of the tendons come on the heel bone. New bone formation in the tendon area (Tendopathy) can be the consequence and must be treated surgically if the pain persists. However, this course is an exception.

Read more on the subject here: Inflammation of the heel

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Athletes (joggers, soccer players, etc.) are particularly often affected by diseases of the foot. In some cases, the cause of the foot discomfort cannot be identified at first.
Therefore, the treatment of the foot (e.g. Achilles tendonitis, heel spurs, etc.) requires a lot of experience.
I focus on a wide variety of foot diseases.
The aim of every treatment is treatment without surgery with a complete recovery of performance.

Which therapy achieves the best results in the long term can only be determined after looking at all of the information (Examination, X-ray, ultrasound, MRI, etc.) be assessed.

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Further information about myself can be found at Dr. Nicolas Gumpert

root cause

The apophysitis calcanei arises from a Imbalance between of the Resilience of the bone in the growth phase and what actually affects it through physical activity / body weight mechanical load.

Calcaneal apophysitis is particularly common active children who move a lot and the heel bone is exposed to high stresses due to sporting activity. Also obese children often show symptoms of apophysitis calcanei, as the high body weight also leads to overloading of the calcaneus.

Other predisposing factors include this Wearing bad or well-worn shoesthat tend to put additional strain on or even rub the movement of the foot when walking. Also special Foot construction variants, such as. of the Arched feet, can lead to excessive stress on the heel bone.
Additional damage to the foot, such as infections and microtraumas, caused by impacts, friction or twisting of the foot, can also contribute to the development of the disease.

Concomitant symptoms

The typical symptom of calcaneal apophysitis is the Heel pain, which developed slowly and does not occur suddenly:

• At the start the pain only expresses itself in the Start upe.g.after getting up, and then gets better with continued gentle exertion.
• In the course the pain remains in motion with the disease always present and worsens with any stress on the foot, such as running or walking.
• After all, symptoms occur even at rest so that the pain also occurs when stretching the Achilles tendon or the calf muscles, or when external pressure is applied to the heel bone.

To the Reduce pain Many children begin to develop after excessive exposure limpto relieve the pressure on the corresponding calcaneus.

Besides the pain, it can be on the heel too Redness and Swelling who can also be pressure-sensitive, but do not necessarily indicate calcaneal apophysitis.

Often there is a limited range of motion in the upper ankle because pulling the foot up with the tip of the foot (dorsiflexion) is already painful.

Read more about the topic here: Heel bone pain

diagnosis

Calcaneal apophysitis must be distinguished from other diseases that are associated with similar symptoms. In order to make a diagnosis, a detailed anamnesis is taken and the complaints are examined. The decisive factors are Heel pain and the patient's circumstances.

Additionally is a X-ray image helpful, which may reveal a fragmented apophysis of the calcaneus. This can also be the case with symptom-free children. The X-ray image is mainly used to rule out other diseases, e.g. Joint problems, injuries to the Achilles tendon or rare tumors.

MRI of the foot

If no clear diagnosis can be made based on the anamnesis and the X-ray and further clarification of the cause of existing unclear pain is desired, an MRI examination can be performed. Bones and soft parts (muscles, tendons) can be displayed very precisely and possibly provide information.

You can find more information on the topic here: Procedure for an MRI examination

With the help of imaging, changes in the apophysis of the heel bone, but also changes in the structure of the foot that lead to incorrect loads, can become visible.

Read more on this topic at: MRI of the foot

Treatment / therapy

The treatment options for heel pain are great diverse.

First of all, it is recommended to use the affected foot / feet save. The heel bone should be loaded as little as possible so that the irritated areas recover can. Sports activities should be paused or at least the feet, such as long runs etc., exclude.

Acute pain can with the help of Painkillers which should only be taken over the period of the acute pain and not for the primary healing of the heel. Also can anti-inflammatory ointments be applied to the heel region, which alleviate inflammatory side effects. In this case, ultrasound treatments can also contribute to healing, as they stimulate the tissue to regenerate.

There is the option one Heel wedge or a Heel cushion to be worn in the shoe so that the shoe is padded in painful areas on the one hand (heel pad / soft heel bedding), but on the other hand it also leads to a reduction in tension on the calf muscles. As a result, the Achilles tendon, which attaches to the heel bone, is less tense, the mechanical pull on the heel bone decreases and, as a result, the pain.

Additionally can Cold applications with ice cause the pain to subside.

If a body weight that is too high is involved in the development of the disease, a Weight reduction worked to prevent other long-term damage as well.

Can also be helpful regular stretching of the calf muscles be to prevent long-term shortening.

Read more about the topic here: Stretching the Achilles tendon and calf muscles

Taping

Taping is one Modern technology, the the Attaching elastic adhesive tapes on painful regions. Taping is used for very different complaints and is painless treatment without side effects very popular.
In the heel area, the application of a tape can relieve the Achilles tendon and relax the calf muscles and thus support the healing process on the heel bone. A combination of a muscle-oriented and a ligament / tendon structure-oriented tape application is carried out.

Correct attachment of the adhesive tape, which is usually done through, is decisive for the effectiveness of the tape Physiotherapists is possible.

Read more about the topic here: Taping an achilles tendinitis

insoles

Heel pain insoles are used for two different reasons. On the one hand, with the help of shoe cushions padded painful areas and enable one more comfortable to wear of the shoe.

On the other hand, there are specially shaped heel wedges, which are intended as an insert in the shoe and which, due to the elevated heel, can Relieve the Achilles tendon.

Sports break with apophysitis calcanei

Physical activity, especially running, jumping, etc., exposes the calcaneus to permanent stress. It is therefore advisable to take a break from the activities described to allow the pain to subside. Are recommended 4-6 weeks breakto ensure complete freedom from pain and to prevent it from occurring again after a few days.

The duration and the extent of the break (little or no stress allowed) must be assessed in consideration of the symptoms. The type of sport practiced and the level of performance also play a decisive role. High-class athletes in adolescence often start training again after pain relief or try to avoid stressful movements and use gentler training methods for a certain period of time.