Dr. Kevin Yip

Dr Kevin Yip
Orthopaedic Surgeon
MBBS(UK), FRCS(EDIN), FAM(SING), FHKCOS(ORTHO)

Featured on Channel NewsAsia

Apohysitis Calcaneii

SYMPTOMS

There is gradual onset of diffuse exercise – induced heel pain or ache around the insertion of the Achilles tendon, most commonly in very young growing athletes of six to twelve years old.

AETIOLOGY

This is a growth-related condition around the vertically positioned apophysis on the calcaneus, where the Achilles tendon inserts. It often affects active children but can cause pain in non-active children as well. It is induced by a local growth spurt in this area but symptoms are made worse by jumping and running. It is often bilateral, sometimes with a time delay between left and right.

CLINICAL FINDINGS

There is tenderness on palpation over the posterior calcaneus and Achilles tendon insertion. Occasionally there are inflammatory signs with redness and increased temperature. Compare to the other side.

INVESTIGATIONS

X-ray is often normal but can sometimes show a fragmented apophysis and should be compared with the other foot. MRI will show bone oedema but is usually not required for the diagnosis.

TREATMENT

This often long-duration ailment responds to conservative treatment including modification of training, gentle heel lifts and natural healing by closing of the apophysis.

REFERRALS

Refer to physiotherapist for advice of alternative training regime for an early return to sport.

EXERCISE PRESCRIPTION

Cycling and swimming and most low-impact activities are good alternatives to keep up general fitness. This is an injury where you can play sports with minor pain in most cases. It is important to inform parents carefully about this condition and not discourage them from letting their child play sports.

EVALUATION OF TREATMENT OUTCOMES

Monitor clinical symptoms and signs.

DIFFERENTIAL DIAGNOSES

Bone tumour (X-ray differentiates); Osteomyelitis (signs of infection such as increased temperature and increased CRP/ESR).

PROGNOSIS

Excellent.

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