🔹 Definition
- Overuse injury of the calcaneal apophysis (heel growth plate).
- Common cause of posterior heel pain in growing, physically active children.
- Self-limiting condition related to growth spurts.
🔹 Epidemiology
- Age: Typically in children aged 8–14 years, often around the pubertal growth spurt.
- Gender: Slight male predominance.
- Risk groups:
- Active children in running/jumping sports (e.g. soccer, basketball, gymnastics).
- Also seen in less active children wearing flat shoes (e.g. skate shoes).
🔹 Pathophysiology
- Traction apophysitis due to repetitive microtrauma.
- Forces involved:
- Heel strike impact during gait.
- Tension from Achilles tendon and plantar fascia.
- Growth plate is weaker than adjacent structures → prone to inflammation.
🔹 Clinical Features
Symptoms:
- Posterior heel pain, often bilateral.
- Pain worsens with physical activity, running, jumping.
- Morning stiffness or pain after rest.
- May have swelling, erythema, or warmth.
Physical Exam:
- Tenderness over the posterior calcaneus.
- Positive Squeeze Test: pain on medial-lateral compression of the calcaneal tuberosity.
- Tight Achilles tendon.
- Antalgic gait or toe-walking in severe cases.
🔹 Differential Diagnosis
- Achilles tendonitis
- Retrocalcaneal bursitis
- Calcaneal stress fracture
- Tarsal coalition
- Osteomyelitis
- Bone cyst or tumour (rule out with imaging if atypical features)
🔹 Imaging
- Clinical diagnosis; imaging often not required unless atypical.
- X-ray:
- May show sclerosis and fragmentation of the apophysis (can be normal variant).
- Helps exclude other causes (e.g. bone cyst, fracture).
- MRI:
- Shows inflammation around apophysis.
- Useful if diagnosis unclear or to rule out stress fracture, osteomyelitis.
- Bone scan: rarely needed; may show increased uptake.
🔹 Management
First-line (Non-operative):
- Activity modification: avoid aggravating sports temporarily.
- Heel pads/cups: to reduce impact.
- Calf/Achilles stretching exercises: especially gastrocnemius-soleus complex.
- Ice: before/after activity to reduce inflammation.
- NSAIDs: for pain and inflammation.
- Short leg cast: rarely needed, for refractory cases.
Operative:
🔹 Prognosis
- Excellent prognosis.
- Resolves with growth plate closure (usually by age 14–16).
- Recurrence is common but declines with skeletal maturity.
🔹 Parent/Patient Education
- Condition is self-limiting and not associated with long-term damage.
- Encourage return to activity once symptoms resolve.
- Emphasise stretching and proper footwear to prevent recurrence.
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