Background
The heel apophysis usually closes by the age of 15.
Diagnosis
H&P:
DDx and Etiology:
Risk Factors:
Common Presentation:
Diagnostic studies: X-Ray is usually normal and so doesn’t help in diagnosis. However, when done may show fragmented or sclerotic calcaneal apophysis.
Treatment
-Activity modification (decrease pain-inducing activities),
-Ice packs and/or moist heat,
-Stretching and strengthening of the gastrocnemius-soleus complex,
-Analgesics/anti-inflammatory medications, and
-Orthotic devices.
Contraindicated: Don’t use therapeutic ultrasound on bone growth plates that are still actively growing.
“Is the most common etiology of heel pain in children, usually occurring between 5 and 11 years of age. It is thought that in these children, the bones grow faster than the muscles and tendons. A tight Achilles tendon then pulls on its insertion site at the posterior calcaneus with repetitive running or jumping activities, causing microtrauma to the area. There may be swelling and tenderness in this area and passive dorsiflexion of the ankles increase the posterior heel pain.” ABFM
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DDx to consider
“-Plantar Fasciitis and Heel pad syndrome. These cause pain on the plantar surface of the heel rather than posteriorly (as in Calcaneal apophysitis)
-Achilles tendinopathy causes tenderness to palpation of the Achilles tendon.
-Tarsal tunnel syndrome is related to compression of the posterior tibial nerve causes neuropathic pain and numbness in the posteromedial ankle and heel.” ABFM
Reference
Diagnosis of Heel Pain. Am Fam Physician. 2012 Feb 1;85(3):247-252. http://www.aafp.org/afp/2011/1015/p909.html