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Calcaneal Apophysitis Pathology

Calcaneal Apophysitis Pathology

Definition

Calcaneal apophysitis is inflammation of the calcaneal growth plate that results in pain and disability.

Overview

Calcaneal apophysitis usually occurs in children ages 10 – 14 prior to fusing of the plate. It can be associated with repetitive stress or with conditions that cause increased tension or traction on the Achilles tendon, such as equinus or excessive pronation.

Clinical Goal for Orthotic Treatment

The goal of orthotic treatment for the patient with calcaneal apophysitis is to reduce tension or traction on the Achilles tendon and prevent calcaneal eversion to diminish stress on the calcaneal apophysis.

Prescription

To prescribe this device check “Calcaneal Apophysitis” under the Pathology Specific Orthoses section (Part A) of the prescription form.

Prescription Recommendations

  • Polypropylene Shell – semirigid
  • Extra Deep Heel Cup – 20mm
    • The extra deep heel cup limits excessive heel eversion. It also prevents calcaneal fat pad expansion to improve cushioning under the heel.
  • Minimum Cast Fill
    • Tight contact with the arch of the foot (total contact orthosis) transfers pressure from the heel and onto the mid-arch.
  • Wide Width
    • A wide orthosis increases arch contact and distributes more ground reactive force to the midfoot and away from the rearfoot.
  • Medial Heel Skive – 4mm
    • The medial heel skive creates a greater force medial to the axis of the subtalar joint helping to reduce excessive subtalar joint pronation and heel eversion
  • 0/0 Rearfoot Post
    • The rearfoot post stabilizes the orthosis in the shoe
  • EVA Cover to Toes
  • Poron Heel Pad
    • Provides greater cushion under heel
  • Heel Lift – 3mm
    • Adding a heel lift to the rearfoot post decreases tension on the Achilles tendon by plantarflexing the foot at the ankle joint

Summary

The orthosis for calcaneal apophysitis is designed to reduce pressure and tension on the posterior heel to improve the symptoms of calcaneal apophysitis. If you have further questions about orthoses for this condition, ProLab clients can contact a Medical Consultant.

References

  1. Micheli LJ, Ireland ML. Prevention and management of calcaneal apophysitis in children: an overuse syndrome. J Pediatr Orthop, 7(1):34-8, 1987
  2. Stess RM. Persistent calcaneal apophysitis. A case report. J Am Podiatry Assoc. Apr;63(4):147-9, 1973
  3. Spencer AM, Person VA. Casting and orthotics for children. Clin Podiatry. Dec;1(3):621-9, 1984
  4. Hendrix CL. Calcaneal apophysitis (Sever disease). Clin Podiatr Med Surg. vi. Review. Jan;22(1):55-62, 2005
  5. Thomson P, Volpe R. Introduction to podopediatrics. 2nd Ed. Elsevier, Churchill, Livingston, Edinburgh, 2001, 341-343
  6. Micheli LJ, Ireland ML. Prevention and management of calcaneal apophysitis in children: An overuse syndrome. Journal Pediatric Orthopedics 7(1):34-38, 1987

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