Clinical Musing (Adolescents)

Adolescent kids are sometimes the hardest people to treat. They are usually pretty nervous about being treated and they are terrible symptom reporters. Although it is difficult, they are usually the most fun to interact with once they get comfortable with you.

The next few post I am going to outline some common adolescent conditions that we see in the clinic. 

Sever's Disease

A young girl came into the clinic, with her mother, complaining of heel and ankle pain. She is a soccer player and is very active. She stated that she has felt progressive increase in pain with running walking. She stated that at this point she is unable to run and that she is unable to walk without limping. She said the whole ankle and heel is painful. What this patient was experiencing was Sever's Disease.

Sever's Disease (also Sever's Apophysitis/Calcaneal Apophysitis) is actually a terrible name for a somewhat common dysfunction. From here on out I will refer to it as Sever's Apophysitis (SA) because it is actually a more accurate description of the condition. SA is not a disease but is rather repetitive structural damage at the growth plate of the heel from the Achilles tendon. This usually happens in growing children that participate in sports. Apophysitis is technical description of a tendon pulling on a bone to the point that the bone starts to pull away from the rest of the bone. As you can imagine this can be a severely (pun totally intended) painful condition. 

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As seen above the Achilles tendon attaches to the heel bone at the posterior foot. In pubescent children, bones tend to grow faster than muscles and this causes increased tension along tendons such as the Achilles  There is a growth plate in the heel bone which can become irritated with this increased tension from the Achilles. This increasing irritation is referred to as Sever's Apophysitis. 

Treatment for this condition is usually manual massage of the calf, gentle and progressive stretching and strengthening activities, possibly bracing and taping techniques. Acutely ice and heat are also helpful. It is also important to hold kids from sports activities in the short run to avoid further injury.

This patient is doing much better and has been able to return to practice recently on a limited program.