Definition
Apophysitis calcanei is a disease of the calcaneus, also called Os calcaneus. It occurs mainly in children between the ages of 8 and 16, who are in the growth phase at this time. Increased mechanical stress can lead to softening of the apophysis (the point of attachment for tendons and ligaments to the bone) of the calcaneus.
This can also lead to an inflammation of the Achilles tendon, which is located at the calcaneus. The disease often occurs on both sides at the same time and manifests itself in heel pain. Boys are more often affected than girls.
Duration
Apophysitis calcanei occurs mainly in children and adolescents, as growth during this period causes a reduced resilience of the affected structures. By sparing the heel, the pain usually subsides quickly, then it is only necessary to take care not to end the break too early in order to prevent a prompt recurrence. A break of 4-6 weeks is therefore recommended.
As a rule, apophysitis calcanei heals without any consequences and at the latest by the end of the growth phase there are no more complaints. In very rare cases, continued stress on the heel can lead to a change in the tendon attachment to the heel bone. This can lead to the formation of new bone in the tendon area (tendopathy) and must be treated surgically if pain persists. However, this course is an exceptional case.
Cause
Apophysitis calcanei is caused by an imbalance between the load-bearing capacity of the growing bone and the mechanical stress actually acting on it through sporting activity/body weight. Apophysitis calcanei is particularly common in active children who move a lot and the heel bone is exposed to high stress due to sporting activity. Overweight children also frequently show symptoms of apophysitis calcanei, as the high body weight also leads to overloading of the calcaneus.
Other predisposing factors include wearing poor quality or worn shoes, which tend to put additional strain on the movement of the foot when walking or even rub it. Special foot construction variations, such as the flat foot, can also lead to excessive strain on the heel bone. Additional damage to the foot, such as infections and micro-trauma, caused by shocks, friction or twisting of the foot, can also contribute to the development of the disease.
Associated symptoms
The typical symptom of Apophysitis calcanei is heel pain, which develops insidiously and does not occur suddenly: to reduce the pain, many children start limping after excessive strain to reduce the pressure on the corresponding heel bone. In addition to the pain, redness and swelling may occur at the heel, which may also be pressure-sensitive, but need not necessarily indicate apophysitis calcanei. Often there is a limited range of motion in the upper ankle joint, as pulling the foot with the tip of the foot pointing upwards (dorsal extension) is already painful.
- At the beginning, the pain only manifests itself when starting to move, e.g. after getting up, and then initially gets better with continued gentle pressure. – In the course of the disease, the pain remains constant under movement and worsens with any load on the foot, such as running or walking. – Eventually, the symptoms even occur at rest, so that the pain also occurs when the Achilles tendon or calf muscles are stretched or when pressure is applied to the heel bone from outside.