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Calcaneal Apophysitis (Severs Disease)

Calcaneal Apophysitis (Severs Disease)

Calcaneal Apophysitis (Severs disease) (Named after JW Sever MD, 1912  –  Sever JW: Apophysitis of the Os Calcis. New York Medical Journal 1912; 95: Page 1025-1029.) By Dennis Rehbock. Sports podiatrist. 26 June 2018. Based on an article written by Dennis Rehbock for SA Pharmaceutical Journal.   X-rays of typical Calcaneal Apophysitis. Severs disease is an inflammation of the heel growth plate that is commonly seen in children. Severs disease is pain in the heel bone (calcaneus) caused by a disturbance of the growth area (growth plate) at the back of the heel where the strong Achilles tendon attaches to it.  This is known as Severs disease or Calcaneal apophysitis.  It is seen most common in boys between the ages of 9 to 12 years of age. These are one of several different ‘osteochondroses’ that can occur in other parts of the body, such as Osgood-Schlatters Disease at the knee joint.   The cause of Severs disease is not entirely clear.  It is most likely due to overuse or repeated minor trauma that happens in a lot of sporting activities such as football and running activities. This trauma affects the cartilage join between the two parts of the growing bone in the heel and results in inflammation and pain. Hard playing surfaces, like those hard football fields in South Africa in winter, increases the risk of this Severs disease. Children who are heavier are possibly at greater risk for developing Severs disease. Tight calf muscles and a pronated foot (flat foot) can also predispose the child to Severs disease. Care must be taken not to diagnose this condition from x-rays. The appearance of Severs disease on is impossible to differentiate from a normal developing heel bone on x-ray. The history of the injury is of great importance. Signs and symptoms. Pain is usually felt at the back and side of the heel bone (body of the heel) and sometimes under the heel as well. The pain is usually relieved when the child is not active and becomes painful with sport. Squeezing the sides of the heel bone is often painful. Running and jumping make the symptoms worse and rest or inactivity will relieve it. One or both heels can be affected. In more severe cases, the child may be limping or walking on their toes. This toe walking can cause Achilles tendon strain and pain in the forefoot. Self...

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Pronation and the Norm…

The foot is designed to pronate / roll inwards a little when we walk or run. This slight pronation is NORMAL PRONATION. The pronation is a shock absorption mechanism of the foot. SO IT IS NORMAL. When the foot pronates too much – excessive pronation – it can cause or contribute to injury in the foot or higher up. So if you pronate NORMALLY then you do not do anything about it. If you pronate excessively AND IT IS CAUSING OR CONTRIBUTING TO INJURY then get an antipronation / supportive shoe. If necessary get an orthotic device to support you. I am going to try and simplify this matter of pronation / overpronation and underpronation / supination. The foot has a complex anatomical structure but in motion it has an even more complex biomechanical function. When running the heel contacts the ground in a turned in position called inverted. From there the foot rolls inwards (pronates) and the forefoot contacts the ground. This normal pronation can be measured to be between 2 and 4 degrees. This phase of the foot function is to absorb shock. From this pronated position the foot rolls to the outside and this is called supination. As this happens the foot locks into a rigid lever to propel us forward.  The foot should move into these various positions at the right time for it to function efficiently and normally. This type of foot is called a neutral or normal functioning foot. In the running population out there most runners do not have these neutral / normal feet. The most common biomechanical malfunction is that of excessive pronation. This means that when the foot is meant to pronate it does not stop at the normal amount and keeps on rolling into an abnormal position called excessive pronation. This abnormal biomechanical malfunction may cause a variety of injuries. There are many runners out there that excessively pronate and do not have any injuries. The opposite of this excessive pronation is excessive supination. This means that the foot does not pronate when it should and the foot stays turned out excessively to the outside. This is also abnormal and may be a cause of injury. To see if you pronate excessively or supinate excessively you need a full biomechanical by a professional. This will include a running shoe examination, a static clinical examination and a running examination. My...

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