Apophysitis of the calcaneus is painful disruption between the calcaneal apophysis and the body of the heel that occurs before calcaneal ossification is complete. Diagnosis is clinical. The mainstay of therapy is stretching the Achilles tendon both passively and actively. Adjunctive measures include use of heel cups/pads and splinting or casting.
(See also Overview of Foot and Ankle Disorders.)
The calcaneus develops from two centers of ossification: one begins at birth, the other usually after age 8. Ossification is usually complete by age 15. The cartilaginous disruption in calcaneal apophysitis may result from an excessive pull on the apophysis by contracted or shortened calf muscles. Bone growth spurts without adaptive calf muscle lengthening may play a role.
Pain develops in patients (usually aged 9 to 14) with a history of athletic activity, especially those who wear footwear without elevation of the heel (such as track flats or soccer cleats); it affects the sides or margins of the heel and is aggravated by standing on tip toes or running. Warmth and swelling are occasionally present.
The diagnosis of apophysitis of the calcaneus is clinical. Radiographs are not usually helpful. MRI may show marrow edema at the apophysis as well as a retrocalcaneal bursa.
Treatment of Apophysitis of the Calcaneus
Passive and active stretching of the Achilles tendon
Heel cups/pads and splinting or casting
Stretching the Achilles tendon both actively and passively provides the best symptomatic improvement.
While seated with an elastic band placed at the ball of the foot, the initial treatment is passive stretching of the foot in dorsiflexion with both the knee flexed and extended.
Photos courtesy of James C. Connors, DPM.
Active stretching of the Achilles tendon using the standing gastrocnemius stretch can decrease the tension on the calcaneal apophysis.
Heel cups may be used to provide cushion to the calcaneus (eg, in athletic cleats). Pads that elevate the heel relieve symptoms by reducing the pull of the Achilles tendon on the heel. Night splints may be used to passively stretch the calf muscles, helping maintain flexibility. Rest, ice, activity modifications, and the use of heel pads usually relieve pain. In more severe or recalcitrant cases, cast immobilization may be used to relieve pain and stretch the calf muscles. Reassurance is important because symptoms may last several months but are self-limiting.
