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Sever’s disease/Calcaneal apophysitis

Calcaneal apophysitis

This condition is also known after doctor who first identified it in 1912 It was called Sever’s disease which does sound rather scary. It is the most common cause of heel pain in children. Podiatrists regularly treat these common injuries when they affect a foot or ankle, at Zest we would recommend our MSK lead.

Symptoms of calcaneal apophysitis

In all growing children there are areas on the bone that are made up of special cells from which the bone will grow. These are called your growth plates or apophysis. The growth plate on the back of the heel bone (calcaneus) is situated where the Achilles tendon connects to it. Bones in children tend to grow quite quickly in comparison to other structures particularly tendons.

As parents can testify when their child goes through a growth spurt can be very quickly over a few weeks. These growth spurts are most prevalent between the ages of 9 and 11 which is the most common time to get calcaneal apophysitis and at the start of a new sporting season.

The shin bone (tibia) starts to grow but unfortunately the Achilles tendon, which does not have as good blood supply as the bone, cannot grow or stretch at the same rate. This means that the Achilles tendon becomes tighter and as they move it pulls with more and more force on the growth plate at the back of the heel bone causing the growth plate to become irritated.

Treatment

If left calcaneal apophysitis will eventually get better by itself within 2 to 4 weeks. But it can become very painful and last longer in which case your podiatrist can help. If the child is not in too much pain they can continue with their activities and use ice regularly on the area to relieve pain. In some cases, a heel raise, or orthosis will help and often stretches are used to help settle the condition more quickly.

The most important thing is to keep the child is comfortable as possible while this condition resolves. We often recommend daily use of trainers or walking shoes until the pain settles. Recurrence of calcaneal apophysitis is not uncommon with each growth spurt but should this occur your podiatrist will tell you how to deal with it. This same sort of condition occurs in other areas of the foot such as at the base of the fifth metatarsal where it is known as Iselin’s disease.

Achilles Tendinitis Post

achilles tendonitis

The Achilles tendon is the tendon that connects the calf muscles to the back of the heel bone. It is a key tendon in providing movement and power on walking. On occasions it can become irritated or thickened as a result of trauma or overuse, causing Achilles Tendinitis. Often changes in heel height of shoes, from high to low, can also create this irritation. During this irritation the Achilles tendon becomes thickened, stiff and painful, particularly on movement after sitting.

It is important to keep the tissues of the tendon moving so rest id not usually recommended unless in high levels of pain. Your podiatrist will be able to examine the area to determine if there is any tearing of the tendon a period of rest or possibly surgery may be required. This can be done using ultrasound imaging that is available in the clinic

Achilles Tendinitis treatment

Once the integrity of the tendon has been determined the podiatrist can then start you on your treatment plan.

This will usually involve stretches and strengthening of the tendon and the calf muscles themselves. In order to help you with this your podiatrist may recommend that we use orthoses to help distribute the stress and strain through the tendon evenly or occasionally strapping to allow you to continue to be active.

In cases of extreme inflammation may be indicated to perform injection therapy. This usually involves a period of immobilisation cast boot.

Given that the Achilles tendon does not have a great blood supply compared to muscles it can take some time to fully recover from injury.

Plantar fasciitis

plantar fasciitis

We use the term Plantar fasciitis to describe a type heel pain. Which results from the deterioration of your plantar fascia. However, today we prefer to call it plantar heel pain syndrome or plantar fasciopathy.

Plantar fasciitis symptoms.

Plantar fasciitis is characterised either firstly by initial step pain or secondly by a pain on weight-bearing after rest. It is a very common condition, for instance around 10% of the population will suffer at some point in their lives.

The pain is usually felt anywhere along the bottom of the foot is typically located underneath the heel. As mentioned previously it is worse first thing in the morning or after long periods of rest once the foot starts moving the pain normally decreases. Plantar fasciitis can occur in people of any age but is usually in adults.

Causes

It is usually as a result of a sudden change in the loading of the heel and its associated structures this can be due to:

  • changes in activity
  • poor footwear
  • sports injury
  • imbalance in the muscles of the legs or hips
  • tight calf muscles

Often other structures than just the plantar fascia can be involved such as the nerves or tendons around the inside of the ankle. Furthermore this can often give subtle changes to the type of pain felt in the heel. Your podiatrist will ask you about this during consultation.

Treatments

The specialist podiatrist here at Zest Podiatry will then have a look at the thickness of the plantar fascia and the integrity of the structures around the area using a diagnostic ultrasound imaging. If this confirms the diagnosis of plantar fasciitis then treatment options can be discussed.

These plantar fasciitis treatment options could include:

The Zest team here will take you through the pros and cons of each treatment option so you can make decision that is right for you.

Why shockwave?

shockwave

Extracorporeal shockwave therapy (ECSWT)

Shockwave therapy is used in the treatment of heel pain and tendon injuries.

The latest research in shockwave reveals it to be as effective for plantar fasciitis as a corticosteroid injection and is very helpful for achilles tendonitis. Its use is supported by the National Institute of Clinical Health and Excellence (NICE).

At Zest we use the best machine on the market the ‘Swiss Dolarclast’. The Swiss Dolarcast is the same type that is used in the NICE research. The machine sends waves of pressure into the tissue encouraging it to heal.

Why does it work?

The machine sends shockwaves from a compressor into a special probe. The probe sends the waves into the damaged area. The waves encourage the damaged tissue to heal at a quicker rate than is normally would.

Does it hurt?

Shockwave is a non-invasive treatment so no skin is broken or damaged. It can be a bit tender during the treatment but this eases in a few seconds.

You can return to normal activity immediately as there is no damage to the area,. We may encourage you to rest and have a cup of tea after.

How many sessions will I need?

We recommend 3 shockwave sessions, a week apart. This gives you the best chance for resolution of pain. Occasionally further sessions are required, although not common we can accommodate this.

How will I know it is better?

Your pain should be gone or much less. But we will have a look with an Ultrasound scanner to see how well the damage tissue is healing.

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