Heel pain in children

Severs Disease/ Calcaneal Apophysitis
Introduction
Calcaneal apophysitis (inflammation of the heel bones growth plate) is a traction apophysitis of the insertion of the Achilles tendon into the calcaneus (heel bone).
Adult heel bones are shaped differently to children heel bones. The fragment of bone not attached to the heel as you see in the picture, is normal for a child below 16 years of age and is known as the growth plate. It€™s the inflammation of this growth plate which causes pain.
As we get older this bone fragment €˜connects€™ itself with the rest of the heel to create the €˜adult heel bone€™ as we know it.
Severs Disease is one of the most common causes of heel pain in children and affects those aged between 8-14years old.
Severs Disease can be present in both males and females however most common in males aged 10 to 12 who are active in sports.
One or both heels can be affected.

Etiology
Severs Disease is caused by a repetitive overuse. An inflammation of the heel growth plate occurs and causes a €˜painful heel€™.
Causes of this inflammation include:
An Increase in activity
Being active and participating in known aggravating sports such as: football, gymnastics, hockey, rugby, tennis, ice skating, ballet and running
Growth Spurts €“ where the long bone of the tibia/fibia grows faster than the tendons
Having a limited €˜Range of Motion€™ in the Ankle Joint or Tight Calf Muscles
Gait abnormalities: in-toed, out-toed, tip toe walking
Biomechanical Abnormalities: Flat feet, over pronation, achilles bowing, limited ankle movement.