Severs is highly prevalent in active kids, especially during winter sport. Severs (Calcaneal apophysitis) is a condition affecting the growth plate in the heel. Due to tractional stresses placed on the heel with activity, the growth plate becomes painful and irritated. It generally presents as painful heels during and after exercise. If the conditions are left unmanaged, it can become quite debilitating and may lead to daily pain and reduced activity levels. This condition can strike at any time between the ages of 8 – 15 however most prevalent 10-11 years of age.
A simple and relatively accurate clinical test for Severs is the heel squeeze. By applying direct medial and lateral (either side) compression to the heel we can test for an irritated growth plate. Risk factors include high activity levels, rapid growth, high BMI, poor footwear, poor biomechanics and tight calf musculature.
Early treatment and intervention for Severs is important to help the child maintain physical activity levels and reduce painful symptoms. Treatment will generally be a combination of exercise rehabilitation, footwear advice and prescription, Icing, taping techniques and in shoe heel lifts to reduce tensile load through the heel (only when warranted). Important to note stretching can make this worse.
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Iselin’s is the tractional apophysitis (growth plate inflammation) of the base of the fifth metatarsal over what is known as the styloid process. This is the prominence half was down the outside of the foot.
This condition is not as common as Severs, but we do see it regularly in clinic. It most commonly presents in active kids as a painful lump on the outside of the foot. They will often experience discomfort from pressure in shoes and increased pain with physical activity.
Activities such as dancing and sports that feature considerable lateral movements like tennis can be aggravating for this condition. Tight calf musculature and rapid growth can also be contributing factors.
It is important to seek professional advice to help manage Iselin’s as it can become debilitating. Simple strapping techniques, Icing, in shoe padding and exercise rehabilitation can help considerably.
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Osgood-Schlatter’s is a common cause of front knee pain in children. The condition is caused by inflammation of the growth plate at the front of the knee where the patellar tendon attaches to the tibial tuberosity. The condition will often present with a painful, swollen lump at the front of the knee and pain with increased activity. Running and jumping sports can predispose to this condition along with periods of rapid growth.
Simple measures such as reducing load, icing, exercise rehab and proper footwear can all help manage this condition. Generally, most symptoms will abate when the growth plate fuses which is around 14 for girls and 16 for boys. If mechanics are not addressed next point of symptoms becomes the patella tendon and assessment and treatment recommended.
If you have any concerns for yourself, or for your children – we encourage you to book for a consultation to discuss your concerns further with our podiatrists.