Introduction:
Plantar Apophysitis is a common commmplaint among children, especially those involved in athlets. This disease also known as Sever’s Disease orcalcaneal apophysitis . This condition is the painful inflammation of the calcaneal apophysis caused by repetitive microtrauma on the unossified apophysis due to traction of the achilis Tendon.
Definition:
Plantar Apophysitis refers to the irritation or inflammation of the growth plate which located at the back of the heel bone (calcaneus). It is not a true” disease” but rather an overuse injury.
Etiology:
The primary cause of plantar apophysitis is repetitive stress and overload on the calcaneal apophysis. During periods of rapid growth, the growth plate is softer and more prone to injury. This C-shaped growth zone becomes inflamed secondary to repetitive traction stress of the Achilles tendon.
Signs & symptoms:
- Heel pain: Increased pain with weight bearing, running or jumping.
- Tenderness: Tenderness on medial and lateral heel compression.
- Stiffness: Limited ankle dorsiflexion range secondary to tightness of the Achilles tendon. The pain gradually resolves with rest. All the sporting activities including running should be discontinued while the child has heel pain.
- Bilateral involvement: affects both heels.
- Limping: May be present, especially after activity.
Risk Factors:
Age: Most common in children aged 8-14.
Foot biomechanics: Biomechanical factors such as genu varum, forefront pes cavovarus or pes planus can alter stress distribution.
Inappropriate footwear: Shoes lacking adequate support or cushioning .
Activity level: Highly active children, especially those participating in sports like basketball, soccer .
Tight calf Muscles or Achilles tendon: Increase tension on the back of leg.
Physiotherapy Management:
Pain management: Rest, Ice application, NSAIDs and activity modification.
Stretching exercise: Stretching of Triceps Surae, Plantar fascia to improve dorsiflexion and strengthening of extensors.
Footwear assessment and modification: Recommending supportive shoes and potentially heel lifts or orthotics to reduce pressure.
Taping: Taping the foot around the arch and heel area has been noted to reduce pain caused by Sever’s disease and ambulation.
Gait analysis: To identify and correct biomechanical imbalances.
Conclusion:
is not unusual for Sever’s disease to recur. This typically happens when a child once again increases sports activities. Wearing sports shoes that provide good support to the foot and heel may help prevent recurrence.Sever’s disease will not return once a child is fully grown and the growth plate in the heel has matured into solid bone.However, proper management, especially through physiotherapy , can significantly alleviate symptoms, prevent recurrence , promote healing and ensuring young athletes can return to their activities safely and comfortably.