Current Insights On Conservative Care For Heel Pain

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A Few Thoughts On Calcaneal Apophysitis

Heel pain in children is commonly caused by calcaneal apophysitis or Sever’s disease. This is a traction apophysitis at the calcaneus due to the pull of the Achilles tendon insertion and the origin of the plantar fascia. Typically, the child is involved in a youth sport or activity, such as soccer, baseball, track or basketball, which involves a lot of running and jumping.

   Usually, the condition will resolve on its own over time but it is helpful to treat symptoms in the active child using many of the aforementioned treatments such as taping, proper shoe recommendations, ice, stretching (not during acute episodes), etc. I like to apply a low Dye strapping with a closed basket weave on the heel. This has worked very well in allowing children to participate in their activity relatively pain free.

   Institute a stretching exercise program for the Achilles tendon and plantar fascia when the child is not in a pain cycle. Addressing footgear is also critical in allowing the child to return to activity and reduce symptoms.

   During the exam, the child with calcaneal apophysitis will have a positive squeeze test with medial and lateral compression over the heel with localized tenderness. The activity level is based on response to treatment and minimizing pain with activity.

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Author(s): 
Tim Dutra, DPM, MS

In Conclusion

A two-pronged approach is helpful in treating heel pain. Most heel pain will respond well to conservative care using this approach. Make sure to address biomechanical issues, footwear considerations and return to activity principles. I rely on taping and athletic footwear prescription as the gold standards of my approach to heel pain. Cross training and exercise prescription are also critical to successful rehabilitation. Stretching programs can be helpful, especially in children with calcaneal apophysitis or plantar fasciitis.

   When the patient is not responding to conservative treatment measures, consider additional diagnostic tests to identify the cause and rule out some of the other differential diagnoses of heel pain. Extracorporeal shockwave treatments or surgical repair may be necessary. Consider post-treatment orthotics and proper footwear to prevent further problems.

   Dr. Dutra is an Assistant Professor in the Department of Applied Biomechanics at the California School of Podiatric Medicine at Samuel Merritt University. He is a podiatric consultant of Intercollegiate Athletics at the University of California. He is a Fellow and Past President of the American Academy of Podiatric Sports Medicine.




References:


1. Anderson MK, Hall SJ, Martin M. Foundations of Athletic Training, third edition, Lippincott, Williams & Wilkins, Philadelphia, 2005.
2. Gordon GM, Contompasisi JP. Sports Medicine, Clinics in Podiatric Medicine and Surgery, W. B. Saunders Co., Philadelphia, October 1986.
3. MacAuley D, Best TM. Evidence-Based Sports Medicine, BMJ Books, London, 2002.
4. Mellion MB, et al. Team Physician’s Handbook, third edition, Hanley & Belfus, Inc., Philadelphia, 2002.
5. Schenck RC Jr. Athletic Training and Sports Medicine, third edition, American Academy of Orthopaedic Surgeons, Rosemont, IL, 1999
6. Valmassy RL. Clinical Biomechanics of the Lower Extremities, Mosby, St. Louis, 1996.
7. Werd MB, Knight EL. Athletic Footwear and Orthoses in Sports Medicine, Springer, New York, 2010.






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Anonymoussays: November 8, 2010 at 6:44 am

All interested might want to check out a systematic review by van de Water et al. (published earlier this year) about the effects of taping on plantar fasciosis.

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