Calcaneal Apophysitis Case Studies

Adolescents present with pain and tenderness over the medial border of the foot,aggravated by running or jumping sports or rubbing footwear.Clinical examination reveals a cornuate prominence on the medial side of the navicular,which may be tender and show pressure from footwear.An x-ray will confirm the presence of an ossicle at the medial border of the navicular(controversy whether a stress fracture, or a separate centre of ossification).Treatment is an arch support and modification of footwear. Acute pain, aggravated byweight bearing may require six weeks of cast immobilisation. Rarely excision of the lesionwith tightening of the tibialis posterior tendon is required.

Osteochondroses

These are idiopathic disorders of enchondral ossification which occur during the years of rapid growth. Trauma may influence their development, particularly from sport.

Freiberg

39). The age of onset of this completely reversible condition is from 2 to 9. Treatment is symptomatic. Supportivecasts for six weeks may be required. With time the bone fully reconstitutes without longterm sequelae.

Sever’s Disease

Sever’s disease or calcaneal apophysitis is a common entity in the 0 to 11 year old agegroup. The child may present with heel pain, particularly with running and a limp.Clinically the calcaneal apophysis is very tender. The tendo-Achilles may be tight.X-rays are not helpful because other calcaneal apophysis is very tender. The tendo-Achillesmay be tight. X-rays are not helpful because the calcaneal apophysis is frequently fragmented and densein normal children.Treatment depends on the severity of the child’s symptoms and includes relative rest, calf stretching and strengthening exercises and occasionally the use of a heel raise. It is a self limiting condition with no adverse long term sequelae.

Osteo-chondral Lesions of the