II. Epidemiology
III. Pathophysiology
- Low grade inflammation and Apophysitis at achilles tendon insertion
- Associated with irregular ossification
- Sclerosis of calcaneal apophysis
- Images
IV. Mechanism
- Traction injury of the achilles tendon insertion at the Calcaneus
V. Risk Factors
- Tight heel cord
- Running or jumping sports
- Early sports specialization
VI. Symptoms
- Heel Pain (often bilateral)
- Wearing shoes is painful (esp. soccer cleats)
- Ambulation is not painful (but weight bearing may exacerbate the pain)
- Pain is worse at the begining of a season or during a growth spurt
VII. Signs:
- Point tenderness over the achilles tendon insertion
-
Calcaneus inflammation
- Local pain
- Tenderness
- Swelling
- Tight heel cord
- Passive dorsiflexion of heel cord reproduces pain
- Pain worse with calcaneus Squeeze Test
- Medial and lateral compression of Calcaneus
VIII. Differential Diagnosis
IX. Imaging: Foot Xray
- Typically normal
- May demonstrate sclerosis of calcaneal apophysis
- However sclerosis also seen in normal, asymptomatic feet
- Evaluate for alternative diagnoses (e.g. Calcaneal Stress Fracture)
X. Management
-
General Measures
- NSAIDs or Acetaminophen
- Local heat
- Relative Rest
- Ice Therapy
-
Orthotics
- Padded heel cup
- Heel lift (1.25 cm)
- Diminishes heel cord stress
- Calf and Heel Cord StretchingExercises
- Focus on gastrocnemius Muscle and soleus muscle Stretching
-
Short Leg Walking Cast (resistant cases)
- Foot in slight equinus (plantar flexion)
- Limit activity to pain free sports during recovery
XI. Course
- Anticipate return to activity within 6 weeks
XII. Prognosis
- Self limited condition with good overall prognosis