Sever's disease - apophyses calcaneal

Sever's disease or calcaneal apophyses apophysis is a painful inflammation calcaniene. It is classified with the child and adolescent nonarticulare osteocondrozele. The etiology of pain in Sever's disease is considered to be weak structure apofizare repetitive trauma induced by the pressure exerted by the Achilles tendon on its insertion. This cause a clinical picture of an infant heel pain in active growth, which worsens the activity.
Heel pain, different from that of adults is very common in children.For those children who experience this pain the most common cause is a disturbance in the development of posterior heel area, the place to catch the Achilles tendon. This is known as severe disease, inflammation or apophyses calcaneal growth plate. It is common between ages 10-14.
When the baby is born most a few bones are still cartilaginous ossification centers. When the heel bone begins to transform in some areas of ossification appear. They are expanding to fill and reinlocui cartilage. One area is the center calcanelor and two in the rear. These two areas shows the cartilage between them. At the age of 16 years when growth is almost complete bone fuse the two areas. Sever's disease is considered to be due to destruction or disturbance of this area of ​​growth.
Pain is felt behind the heel. Relieved when the child is not active and becomes painful during sport. Palpation of the posterior heel is painful. Running and jumping cause worsening of symptoms.One or both heels may be affected.
If symptoms are severe indicates nonsteroidal anti-inflammatory administration. In severe cases the leg may be immobilized in a cast for 2-6 weeks to allow healing. Sever disease is self-limiting and the symptoms will disappear when the two centers of ossification of calcanelor will merge.
Pathogenesis
Calcaneal apophyses develop as an independent center of ossification. Appears in boys 9-10 years and merge at 17, appears in girls at ages younger than. During the rapid growth around puberty seems to be apophyses weakened due to increased cartilage calcification. Microfractures are considered to occur due to normal progression leading to the division of stress fracture healing.This theory explains the clinical and radiographic appearance resorptiei, high fragmentation and sclerosis leading to an eventual union. Mastoid radiographs showing fragmentation diagnoses because there are not multiple ossification centers in normal apophyses. However the degree of damage that occurs in children who have clinical symptoms of illness appear to be more pronounced.
Causes and risk factors:Sever's disease is considered to be caused by low resistance to the distribution of forces at the interface of bone growth. Studies indicate that traction apophyses are more than epiphyses fibrocartilaj composition which are subject to higher axial loads of weight and are composed mainly of hyaline cartilage. Anatomy of the mastoid calcaniene borrow significantly due to stress its vertical orientation and direction of the group drawing strong gastrocemieni muscle.
Signs and symptoms
Sever's disease occurs more frequently in boys 10-12 years.Typical clinical presentation belongs to a physically active child to experience pain in the heel made worse by sports, especially sports that involve running and jumping. Onset is usually gradual.Often the pain is relieved by rest. When the pain continues to engage in sports and daily activities of patient medical consultation is indicated.
Physical Exam:It depends on the severity and duration of damage. Bilateral impairment is present in approximately 60% of cases. Most patients experience pain on deep palpation of the Achilles tendon and pain when lifting the big toe turn. Dorsiflexia forced ankle is uncomfortable and is relieved by passive equinus position.Swelling may be present but is usually mild. In cases of long duration may increase child calcanelor size.
Disease progression:Although not recognized no long term sequelae of untreated illness. Sever's disease cause pain that limits activities of sports, and left untreated can limit even simple physical activities daily.
Diagnosis
Imaging Studies:Radiograph demonstrates extensive sclerosis and fragmentation calcaniene apophysis. The Elements of observed are nonspecific and present in healthy patients. Also. Radiographic evaluation is beneficial to exclude fracture or a rare tumor.The differential diagnosis is made with the following conditions: Achilles tendon pathology, calcaneal fracture, osteomyelitis, tarsus merger.
Treatment
As your child becomes involved in sports at an early age increases the incidence syndromes overutilization of bone and joint mechanics. Sever's disease occurs when the cause painful limitation of sports activities of patients and worried parents.Treatment aims to reduce pain and physical restrictions, and prevention of recurrence. It is usually necessary to limit physical activity. In patients with symptoms not severe enough to indicate the restriction of sporting activities and wearing shoes with heels, participation in exercise programs to stretch and judicious administration of NSAIDs, reduce symptoms and allow continuation of normal participation. If symptoms worsen indicate modification activities.