Dealing With Calcaneal Apophysitis

Overview

Sever?s disease is a heel problem that is the most common cause of heel pain that commonly occurs in children. It is caused by repetitive use and overuse of the heel while it is still growing, therefore is more common in active children and teenagers. Despite the name, Sever?s Disease like Osgood- Schlatter disease is caused by overuse and is not a disease.

Causes

During the growth spurt of early puberty, the bones often grow faster than the leg muscles and tendons. This can cause the muscles to become very tight and overstretched, the heel becomes less flexible and this build-up of pressure can result in redness, swelling, tenderness and pain at the heel.

Symptoms

Athletes with Sever?s disease are typically aged 9 to 13 years and participate in running or jumping sports such as soccer, football, basketball, baseball, and gymnastics. The typical complaint is heel pain that develops slowly and occurs with activity. The pain is usually described like a bruise. There is rarely swelling or visible bruising. The pain is usually worse with running in cleats or shoes that have limited heel lift, cushion, and arch support. The pain usually goes away with rest and rarely occurs with low-impact sports such as bicycling, skating, or swimming.

Diagnosis

You may have pain when your doctor squeezes your heel bone. You may have pain when asked to stand or walk on your toes or on your heels. You may have pain in your heel when your doctor stretches your calf muscles. Your doctor may order x-rays of the injured foot to show an active growth plate.

Non Surgical Treatment

The primary method of treating Sever?s disease is taking time off from sports and other physical activities to alleviate the pressure on the heel bone. During the healing period, your child?s doctor may also recommend physical therapy or any type of exercise that involves stretching and strengthen leg muscles and tendons. Wrapping ice in a towel and placing it under the child?s heel will also help to alleviate and reduce pain and swelling.

Recovery

In some cases, children will simply outgrow Sever’s Disease when they reach a certain age, but this does not mean that symptoms should be ignored. If children express that they are in pain, this should always be taken seriously by their parents or guardians. Heel pain may be a sign of Sever’s Disease and this condition should not be left untreated, due to the damage it can cause to the growing heel bones. Scheduling a doctor’s appointment is always the first step to take in gaining a diagnosis of symptoms and speedy help for the child.

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Achilles Tendon Rupture How Do I Know I Have Got It?

Overview
Achilles Tendon
The Achilles tendon is the largest tendon in the human body. It connects the calf muscle to the heel bone. However, this tendon is also the most common site of rupture or tendonitis, an inflammation of the tendon due to overuse. Achilles tendon rupture is a partial or complete tear of the Achilles tendon. It comes on suddenly, sometimes with a popping sound, and can be debilitating. A full rupture is more severe, but less common, than a partial rupture. A full rupture splits the Achilles tendon so that it no longer connects the calf muscle to the heel: the calf muscle can no longer cause the foot to ?push off?, so normal walking is impossible. If it is a full rupture, then lightly pinching the Achilles tendon with the forefinger and thumb will reveal a gap in the Achilles tendon. Partial and full Achilles tendon ruptures are most likely to occur in sports requiring sudden stretching, such as sprinting and racquet sports. Partial Achilles tendon tears are also common among middle and long distance runners.

Causes
As with any muscle or tendon in the body, the Achilles tendon can be torn if there is a high force or stress on it. This can happen with activities which involve a forceful push off with the foot, for example, in football, running, basketball, diving, and tennis. The push off movement uses a strong contraction of the calf muscles which can stress the Achilles tendon too much. The Achilles tendon can also be damaged by injuries such as falls, if the foot is suddenly forced into an upward-pointing position, this movement stretches the tendon. Another possible injury is a deep cut at the back of the ankle, which might go into the tendon. Sometimes the Achilles tendon is weak, making it more prone to rupture. Factors that weaken the Achilles tendon are corticosteroid medication (such as prednisolone), mainly if it is used as long-term treatment rather than a short course. Corticosteroid injection near the Achilles tendon. Certain rare medical conditions, such as Cushing?s syndrome, where the body makes too much of its own corticosteroid hormones. Increasing age. Tendonitis (inflammation) of the Achilles tendon. Other medical conditions which can make the tendon more prone to rupture, for example, rheumatoid arthritis, gout and systemic lupus erythematosus (SLE) – lupus. Certain antibiotic medicines may slightly increase the risk of having an Achilles tendon rupture. These are the quinolone antibiotics such as ciprofloxacin and ofloxacin. The risk of having an Achilles tendon rupture with these antibiotics is actually very low, and mainly applies if you are also taking corticosteroid medication or are over the age of about 60.

Symptoms
You may notice the symptoms come on suddenly during a sporting activity or injury. You might hear a snap or feel a sudden sharp pain when the tendon is torn. The sharp pain usually settles quickly, although there may be some aching at the back of the lower leg. After the injury, the usual symptoms are a flat-footed type of walk. You can walk and bear weight, but cannot push off the ground properly on the side where the tendon is ruptured. Inability to stand on tiptoe. If the tendon is completely torn, you may feel a gap just above the back of the heel. However, if there is bruising then the swelling may disguise the gap. If you suspect an Achilles tendon rupture, it is best to see a doctor urgently, because the tendon heals better if treated sooner rather than later. A person with a ruptured Achilles tendon may experience one or more of the following. Sudden pain (which feels like a kick or a stab) in the back of the ankle or calf, often subsiding into a dull ache. A popping or snapping sensation. Swelling on the back of the leg between the heel and the calf. Difficulty walking (especially upstairs or uphill) and difficulty rising up on the toes.

Diagnosis
The diagnosis of an Achilles tendon rupture can be made easily by an orthopedic surgeon. The defect in the tendon is easy to see and to palpate. No x-ray, MRI or other tests are necessary.

Non Surgical Treatment
The best treatment for a ruptured Achilles tendon often depends on your age, activity level and the severity of your injury. In general, younger and more active people often choose surgery to repair a completely ruptured Achilles tendon while older people are more likely to opt for nonsurgical treatment. Recent studies, however, have shown fairly equal effectiveness of both operative and nonoperative management. Nonsurgical treatment. This approach typically involves wearing a cast or walking boot with wedges to elevate your heel; this allows the ends of your torn tendon to heal. This method can be effective, and it avoids the risks, such as infection, associated with surgery. However, the likelihood of re-rupture may be higher with a nonsurgical approach, and recovery can take longer. If re-rupture occurs, surgical repair may be more difficult.
Achilles Tendonitis

Surgical Treatment
This injury is often treated surgically. Surgical care adds the risks of surgery, there are for you to view. After the surgery, the cast and aftercare is typically as follows. A below-knee cast (from just below the knee to the tips of the toes) is applied. The initial cast may be applied with your foot positioned in a downward direction to allow the ends of the tendon to lie closer together for initial healing. You may be brought back in 2-3 week intervals until the foot can be positioned at 90 degrees to the leg in the cast. The first 6 weeks in the cast are typically non-weight bearing with crutches or other suitable device to assist with the non-weight bearing requirement. After 6 weeks in the non-removable cast, a removable walking cast is started. The removable walking cast can be removed for therapy, sleeping and bathing. The period in the removable walking cast may need to last for an additional 2-6 weeks. Your doctor will review a home physical therapy program with you (more on this program later) that will typically start not long after your non-removable cast is removed. Your doctor may also refer you for formal physical therapy appointments. Typically, weight bearing exercise activities are kept restricted for at least 4 months or more. Swimming or stationary cycling activities may be allowed sooner. Complete healing may take 12 months or more.