Understanding Calcaneal Apophysitis: Causes, Symptoms, Treatment, and Preventive Strategies for Young Athletes

Calcaneal apophysitis, commonly referred to as Sever’s disease, is a condition that frequently affects athletic children, particularly during periods of growth. It occurs when the growth plate at the back of the heel bone (calcaneus) becomes inflamed. This inflammation leads to pain, which can significantly impact a child’s ability to participate in sports and other physical activities. Understanding the causes, symptoms, and treatment options for calcaneal apophysitis is essential for parents, coaches, and young athletes to manage this condition effectively and prevent its occurrence.

The primary cause of calcaneal apophysitis is overuse of the heel, particularly in children aged 8 to 14 years. During this growth phase, the heel bone is still developing and is more susceptible to injury (Achar and Yamanaka, 2019). Activities that involve running and jumping, common among young athletes, can place excessive strain on the heel’s growth plate. Various factors can influence the risk of developing Sever’s disease, including playing high-impact sports without proper conditioning and wearing inadequate footwear (Nieto-Gil et al., 2023). Additionally, children with certain foot types, such as flat feet or high arches, may be at greater risk due to structural differences (Fares et al., 2023).

The symptoms of calcaneal apophysitis primarily include heel pain, which may worsen with activity. The pain is often localized to the back or bottom of the heel and can make it difficult for children to walk, run, or participate in sports effectively (Ramponi and Baker, 2019). Some children may experience swelling or tenderness around the heel area. The severity of pain can vary significantly; some may have mild discomfort, while others may experience severe pain that could limit their physical activities (James et al., 2015). It’s also worth noting that this condition can affect the quality of life in children, as the pain can hinder participation in sports and increase frustration (James et al., 2016).

Treatment for calcaneal apophysitis typically focuses on reducing pain and inflammation while allowing the heel to heal. Initial treatment usually involves resting the affected foot and avoiding activities that aggravate the pain (Belikan et al., 2022). Icing the heel can help reduce swelling and discomfort. Over-the-counter pain relievers, such as ibuprofen or acetaminophen, may also be recommended for pain management (Haines et al., 2022). In some cases, a doctor may suggest physical therapy to strengthen the muscles around the heel and improve flexibility, thereby decreasing the risk of future injuries (Ceylan and Caypinar, 2018).

In addition to rest and therapy, using supportive footwear is crucial for treatment. Shoes designed specifically for sports can provide adequate cushioning and support, which can alleviate stress on the heel. Orthotic inserts may also be beneficial for children who have foot structure irregularities, enhancing stability and comfort during physical activities (Fares et al., 2023). If conservative treatments fail, more advanced interventions, such as custom orthotics or, in rare instances, surgery may be considered for persistent cases (Yachaoui et al., 2024).

Preventive measures play a vital role in managing calcaneal apophysitis, especially for athletic children. Parents and coaches should encourage a gradual increase in activity levels, allowing the body to adapt to new stresses. Effective warm-up routines that include stretching exercises can prepare the muscles and tendons around the heel, reducing the risk of injury (Haines et al., 2022). Children should also be educated on the importance of proper shoes and should be fitted for sports footwear that provides adequate support and cushioning (Ceylan and Caypinar, 2018).

Furthermore, monitoring training schedules and ensuring adequate rest days are essential steps in prevention. Overtraining significantly increases the risk of developing calcaneal apophysitis, leading to pain and potential long-term consequences (Nieto-Gil et al., 2023). Coaches should design training programs that incorporate both skill development and rest, focusing on balanced approaches that minimize injury risks (Belikan et al., 2022).

Calcaneal apophysitis is a common issue among athletic children, primarily caused by overuse and increased physical activity during critical growth phases. Symptoms include localized heel pain, which can significantly impact a child’s ability to participate in sports. Effective treatment options encompass rest, supportive footwear, and, in some cases, physical therapy. Prevention is critical, and both parents and coaches play indispensable roles in ensuring that young athletes engage in safe practices. By understanding the causes, recognizing symptoms, and implementing preventive measures, families can help minimize the impact of this condition, ensuring that children can enjoy sports and physical activities without pain. Continued awareness and education about calcaneal apophysitis will foster healthier athletic experiences for children (Achar and Yamanaka, 2019; Fares et al., 2023; Haines et al., 2022).

Citations:

James, A.M., Williams, C.M., Luscombe, M., Hunter, R. and Haines, T.P., 2015. Factors associated with pain severity in children with calcaneal apophysitis (sever disease). The Journal of pediatrics, 167(2), pp.455-459. https://www.sciencedirect.com/science/article/pii/S0022347615004370

Belikan, P., Färber, L.C., Abel, F., Nowak, T.E., Drees, P. and Mattyasovszky, S.G., 2022. Incidence of calcaneal apophysitis (Sever’s disease) and return-to-play in adolescent athletes of a German youth soccer academy: a retrospective study of 10 years. Journal of orthopaedic surgery and research, 17(1), p.83. https://link.springer.com/article/10.1186/s13018-022-02979-9

Fares, M.Y., Baydoun, H., Khachfe, H.H., Salhab, H.A., Fares, J. and Musharrafieh, U., 2023. Clinical and diagnostic characteristics of calcaneal apophysitis: a systematic review and thematic analysis. Journal of the American Podiatric Medical Association, 113(4). https://japmaonline.org/view/journals/apms/113/4/22-083.xml

Ceylan, H.H. and Caypinar, B.A.R.I.Ş., 2018. Incidence of calcaneal apophysitis in Northwest Istanbul. BMC musculoskeletal disorders, 19(1), p.267. https://link.springer.com/article/10.1186/s12891-018-2184-6

James, A.M., Williams, C.M. and Haines, T.P., 2016. Health related quality of life of children with calcaneal apophysitis: child & parent perceptions. Health and Quality of Life Outcomes, 14(1), p.95. https://link.springer.com/article/10.1186/s12955-016-0497-4

Haines, M., Pirlo, L., Bowles, K.A. and Williams, C.M., 2022. Describing frequencies of lower-limb apophyseal injuries in children and adolescents: a systematic review. Clinical Journal of Sport Medicine, 32(4), pp.433-439. https://journals.lww.com/cjsportsmed/fulltext/2022/07000/describing_frequencies_of_lower_limb_apophyseal.16.aspx

Ramponi, D.R. and Baker, C., 2019. Sever’s disease (calcaneal apophysitis). Advanced emergency nursing journal, 41(1), pp.10-14. https://journals.lww.com/aenjournal/FullText/2019/01000/Sever_s_Disease__Calcaneal_Apophysitis_.3.aspx

Nieto-Gil, P., Marco-Lledo, J., Garcia-Campos, J., Ruiz-Munoz, M., Gijon-Nogueron, G. and Ramos-Petersen, L., 2023. Risk factors and associated factors for calcaneal apophysitis (Sever’s disease): a systematic review. BMJ open, 13(6), p.e064903. https://bmjopen.bmj.com/content/13/6/e064903.abstract

Achar, S. and Yamanaka, J., 2019. Apophysitis and osteochondrosis: common causes of pain in growing bones. American family physician, 99(10), pp.610-618. https://www.aafp.org/pubs/afp/issues/2019/0515/p610.html

Yachaoui, S., Lokman, B., Aymane, A., Mahla, H., El Oumri, A.A. and EL OUMRI, A.A., 2024. Solving the Puzzle: A Compelling Case Study of Calcaneal Apophysitis With Achilles Tendon Calcification in a 14-Year-Old Patient. Cureus, 16(8). https://www.cureus.com/articles/268102-solving-the-puzzle-a-compelling-case-study-of-calcaneal-apophysitis-with-achilles-tendon-calcification-in-a-14-year-old-patient.pdf