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What this article tells you

  • What the most common cause of heel pain is in active young children
  • How to understand it
  • Presentation and expected findings
  • Differential diagnosis (things to look out for)
  • Management and treatment
  • Contacting our podiatrists

With the beginning of the new sports season we often seen an influx of children between the ages of 8-15 present with painful heels after their sports games. This is often related to a condition called Sever’s Disease.

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What is Sever’s Disease?

‘Sever’s’ or ‘Sever’s Disease’ is the irritation of the heel growth plate(s) and is the most common cause of heel pain in growing, active children.

Although ‘Sever’s Disease’ sounds a bit sinister, it is actually not a ‘disease’ and the prognosis is a self-limiting, benign syndrome which means it resolves when the growth spurt stops, without any long term complications. However, the symptoms during the flare up period can be quite painful and may need Podiatric management.

What is the cause?

Officially it is “A painful inflammation of the calcaneal apophysis due to repetitive trauma which aggravates the insertion of the Achilles tendon.”

I like to explain it a bit more simply as an overuse of the bone and tendons around the heel during a growth spurt. It occurs commonly in children with feet that roll in, and who are active and are growing.

How does it present, what are the symptoms?

Sever’s is commonly found in active children and it’s usually aggravated by walking, running or jumping. It is associated with pain in the back and sides of the heel over the growth plate area of the calcaneus (heel bone).

Typical history:

  • Pain experienced over the epiphyseal (growth plate) area of one or both heels
  • Children experiencing a growth spurt
  • Symptoms during the beginning of the sports season
  • Recently participating in explosive sport
  • Limp after exercise due to severity of pain
  • Increase in activity causing pain
  • Biomechanical abnormalities such as excessive pronation or restricted joints
  • Tight calves (triceps surae complex)
  • Slow onset of pain, with difficulty pinpointing events that could have caused the problem

Some other common characteristics of Sever’s:

  • Seen in both heels in 60% of cases
  • Usually manifests between 8-14 years old with a higher incidence in boys than girls but most common in boys aged 10-12 during a growth spurt
  • Quite often at the beginning of a sport season
  • More common in active children that participate in explosive sports such as soccer, basketball, softball, dancing and gymnastics

Expected findings:

  • A positive (painful) rearfoot “squeeze test” of the heel area
  • Unilateral or bilateral heel pain over the growth plate area
  • Limited ankle joint dorsiflexion
  • Tight gastrocnemius / soleus complex
  • Underlying biomechanical deformity of variable nature (for e.g. hyperpronation of the rearfoot)
  • Worsening pain with increased activity
  • Child may limp when walking
  • Swelling may be present but usually is mild. In long-standing cases, the child may have calcaneal enlargement (this is rare)
  • Plain x-ray of the heels can, but not often demonstrate inflammation of the heel(s)

Prognosis

  • Self-limiting, benign syndrome
  • There is no credible long-term research that exists for the sequel of untreated Sever’s disease, but it does cause limitations in participation and performance in sports
  • If left untreated this can cause major restriction in basic life activities until symptoms resolve when the growth plates fuse

To make a booking call 08 83634588 or contact us via our contact page.

Differential diagnosis – what we want to make sure we rule out!

The key characteristics of a differential diagnosis is having a negative squeeze test of the heel.

This then requires further investigation for other possible problems.

Traumatic events causing heel pain have key differentiating characteristics and good history taking is essential.

Further investigation with imaging such as x-ray, ultra sound and MRI is warranted to rule out more serious problems if deemed necessary.

Infective and internal causes of heel pain usually involve other key characteristics such as systemic symptoms including malaise (tiredness/ fatigue), a raise in core temperature, night pain, or generalised aches.

Treatment of Sever’s Disease

Stage 1 – Rest and recovery

  • RICE therapy (Rest, Ice, Compression, Elevation)
  • Anti-inflammatory medication (NSAID’s)
  • Taping
  • Modified rest or cessation of sports
  • Protective weight bearing using crutches etc (depending on severity)

Stage 2 – Increasing strength and biomechanical correction

Some examples:

  • Heel lifts
  • Taping
  • Anti-inflammatories (NSAID’s)
  • Orthoses (all types) or mobilizations to correct biomechanics
  • Specific stretching exercises
  • Plantar fascial stretching
  • Padding for shock absorption or strapping of heel
  • Complete shoe wear evaluation
  • Adequate shock absorption/rigid heel counter for shoes
  • Gradually increase activity levels (load management programs), including low-impact exercises such as cycling and swimming
  • Graduate back to sport, monitoring pain and symptoms.
  • With clinical signs of diminished pain or eliminated pain, increase the activity levels back to normal.

To make a booking call 08 83634588 or contact us via our contact page.

References:
Sever JW. Apophysitis of the os calcis. N Y Med J. 1912;95: 1025–1029.
Sharfbillig RW, Jones S, Scutter SD. Sever’s disease: what does the literature really tell us? J Am Podiatr Med Assoc. 2008;98:212–223.
Suneel B. Practical pointers on treating Sever’s disease in young athletes. Podiatry Today. 2011;24(10):20-21.
Chiodo WA, Cook KD. Pediatric heel pain. Clin Podiatr Med Surg 2010;27:355–67.
Micheli LJ, Ireland ML. Prevention and management of calcaneal apophysitis in children: an overuse syndrome. J Pediatr Orthop 1987;7:34–8.
Rachel JN, Williams JB, Sawyer JR, Warner WC, Kelly DM. Is radiographic evaluation necessary in children with a clinical diagnosis of calcaneal apophysitis (sever disease)?. J Pediatr Orthop. 2011 Jul-Aug. 31(5):548-50.
Volpon JB, Filho GDC. Calcaneal apophysitis: a quantitative radiographic evaluation of the secondary ossification center. Arch Orthop Trauma Surg. 2002;122:338–341.

With the oncoming summer weather it is time to unveil our feet for all to see (and often judge) as we leave our closed-in winter shoes for sandals and thongs. Our feet are a good indicator of our general health and reflect our vascular, neurological and immunological status, providing your Podiatrist with early warning signs of poor health. The feet are the last part of the body to be reached by the blood vessels and nerves and therefore will be one of the first areas to show signs of neurovascular diseases such as diabetes. Our skin is the largest organ in the body and relies on good health to maintain its integrity. Adelaide’s hot, dry weather and water quality are very harsh for our skin and if not cared for properly, the skin can dry out and crack, creating an opportunity for infection.

Caring for your feet and preventing unsightly callus and fissuring is simple if your feet are well maintained. At PodSquared Podiatry we assess our clients individual needs and health status before recommending the most suitable programme of care to maintain good skin integrity through the summer months.

Callus will naturally build up around the heels as you wear open heeled shoes or sandals through summer. If the callus is allowed to become too thick it will split right down to the delicate skin underneath. These deep cracks (fissures) are painful, often bleed and can be the site of infection.

Simple home care should involve daily inspection of your feet, regular, gentle exfoliation and daily application of a suitable moisturiser. Your Podiatrist can advise you on the best combination of treatment and type of moisturising cream to provide the best results for your feet and overall foot health.

If your feet need some attention or just some simple professional advice to be “summer ready”, contact us for an appointment.

Plantar fasciitis & Plantar Heel Pain Syndrome – What’s the difference?

Plantar fasciitis, or Plantar Heel Pain Syndrome (PHPS) is one of the most common conditions that presents to our clinic and is one of the most common causes of chronic heel pain in the adult population. Plantar Heel Pain Syndrome is a musculo-skeletal disorder affecting the insertion of the plantar fascia into the heel bone. Although this condition is commonly referred to as plantar fasciitis, recent research indicates that inflammation is rarely observed and therefore the “itis” should be dropped. Plantar Heel Pain Syndrome also acknowledges the complexity of this condition as it develops over time, involving more muscles and structures as people try to adapt to the pain. It is thought to be linked to an increased BMI and poor biomechanics, but there are generally a wide range of contributing factors. These factors can be changes in activity and footwear or problems in other parts of the kinetic chain such as knee, hip or back injury.

Plantar Heel Pain Syndrome is often seen in patients that are trying to improve their fitness, lose weight or preparing for that long awaited overseas holiday. It is marked by pain on rising, as people get out of bed, or after prolonged sitting. This pain will often resolve within the first few steps of walking and the patient will usually forget about it until the next morning. As this pattern continues and develops, it takes longer and longer for the pain to disappear until eventually it stays all morning or all day. The inside edge of the heel itself is painful to pressure and can extend into the arch of the foot.

Treatment of Plantar Heel Pain Syndrome

It is important to seek professional help as soon as possible. Early intervention leads to early resolution of this condition. Your Podiatrist will often use a combination of treatments depending on specific diagnosis and the severity of the heel pain, these may include;

  • Taping of the heel and plantar fascia in the short term.
  • Stretching and exercises to restore normal function to the ankle and rear foot.
  • Mobilisation of the ankle and rear foot to restore normal function.
  • Footwear assessment and advice.
  • Acupuncture or dry needling of relevant structures to relieve pain.
  • Prescription of generic or custom orthoses to balance foot posture and reduce mechanical stress on the heel.

For further information or advice, contact us for an appointment.

Foot pain is very common during pregnancy as an inevitable consequence of weight gain (mostly the weight of the baby) and ligament softening hormones, but that doesn’t mean you have to just grin and bear it. We have compiled a list of ten tips that are simple to follow and should help to keep to feet feeling as comfortable as possible.

  1. Wear comfortable supportive shoes with a bit of shock absorption, your feet will not have to work so hard to keep you stable. You may find that your feet increase in size as your pregnancy progresses due to swelling and stretching. Have your feet professionally fitted and avoid tight, restrictive footwear.
  2. Wear socks with loose tops and avoid anything that will restrict circulation to your feet.
  3. Regular low impact exercise such as walking, swimming and yoga are good choices to improve the circulation of blood and reduce swelling in your feet and legs. If you are sitting for extended periods at work, be sure to take regular breaks to stand, walk and stretch throughout the day.
  4. Stretch! Develop and practice a daily routine of foot, leg and calf stretches. Your feet are working much harder than usual and may be prone to cramping and tightness. A routine of stretching will keep your legs from feeling heavy and uncomfortable.
  5. Elevate your feet as much as possible to minimise swelling.
  6. Avoid crossing your legs as this restricts blood flow and increases swelling.
  7. Drink plenty of water. Drinking plenty of water helps to reduce fluid retention.
  8. Eat a healthy and well balanced diet. Avoid foods that are high in salt as they can lead to fluid retention.
  9. Sleep on your left side. Sleeping on your left opens up your blood vessels and allow more fluid to flow upwards from your feet.
  10. Ingrown toenails can be a risk resulting from tight shoes that push the skin around nails cut too short. Keep your nails healthy and check them regularly for signs of injury or infection.

If you would like more information or assistance from one our trained Podiatrists, please contact us to make an appointment

 

This information is based on materials supplied by the Australian Podiatry Association (SA).

Most people are aware that a sedentary lifestyle, smoking and eating fatty foods leads to the narrowing of the arteries and blood vessels of  the heart. Over time, this creates a build up of fatty deposits that can reduce and eventually block the flow of blood in those vessels, which can lead to heart attack and stroke. This process is not restricted to the arteries and vessels of the heart, but affects the entire vascular system. Considering that the circulation of the feet and legs is the furthest from the heart, a common side effect and often a precursor to heart attack and stroke is an identical narrowing of the arteries in the feet and legs, known as peripheral arterial disease (PAD). More than one in ten adults suffer from peripheral arterial disease and left untreated, the condition can have serious effects on the feet including increased risk of amputation as well as increased risk of death.

Early diagnosis and treatment of problems with the feet can prevent heart disease and the risk of serious problems to the feet, yet peripheral arterial disease is often undiagnosed and often asymptomatic. People in high-risk categories for developing peripheral arterial disease include smokers; diabetics; people suffering from obesity; a family history of peripheral arterial disease, heart disease and stroke; high blood pressure; high cholesterol; and being older than 50 years of age. If you are at an increased risk of peripheral arterial disease it is important to see a Podiatrist for a check up, as catching the the problem early can be both limb and life-saving.

Leading a healthy lifestyle and taking care of your feet is the best way to avoid disease and limit complications. Eat a varied diet low in saturated fats, exercise regularly and avoid tobacco. These steps alone will lower the the build up of fatty deposits in the arteries , increase the flow of blood and oxygen to your feet, and reduce the risks from narrowed arteries caused by smoking. Take care of your feet by washing them daily in warm soapy water, and check for any sores or symptoms of disease.

Symptoms of Heart-Related Foot Problems

Diagnosis of problems with the feet can prevent heart disease and the risk of serious problems to the feet, including amputation. Yet peripheral arterial disease is often undiagnosed. If you have any of the symptoms of peripheral arterial disease it is important to make an appointment with a Podiatrist or medical professional as soon as possible. The main symptoms are described below:

  • Loss of sensation: numbness or weakness in the lower legs and feet are common symptoms of peripheral arterial disease.
  • Cramps: cramping in the muscles of the feet and legs can be very painful and are often associated with exercise.
  • Cold feet or legs: If you are struggling to warm your feet or legs or find that they are always colder than the rest of your body, this is an indication that your circulation is restricted. This is particularly worrying for heart health if one leg is noticeably colder than the other.
  • Persistent wounds: sores on the legs, feet or toes that fail to heal indicate peripheral arterial disease. Wounds that fail to heal are a sign that blood isn’t circulating well enough to promote new cell growth.
  • Colour differences: If part of the feet or legs changes colour this could be an indication that blood flow is reduced to those areas.
  • Slow growth of hair and nails: less hair than usual and slow growing toenails are both symptoms of peripheral arterial disease.
  • Skin changes: shiny skin on the legs is a  symptom of peripheral arterial disease.
  • Weak pulse: the absence of a pulse or a very weak pulse in the toes, feet or legs indicates that blood flow is definitely restricted.

Top Five Tips to Avoid Heart- Related Foot Problems

Most diseases are avoidable by leading a healthy lifestyle, and in the case of peripheral arterial disease, lifestyle changes can be the key to saving a leg or escaping premature death. Listed below are the five main points that can be controlled without medical intervention to prevent serious foot problems including painful cramps, wounds that fail to heal and amputation, as well the prevention of heart attack and stroke.

  1. Quit Smokingsmoking narrows the arteries, making it more difficult for the blood to circulate to the feet and legs. Quitting can both prevent disease and make existing disease easier to fight.
  2. Maintain blood glucose levelspeople with diabetes should keep blood glucose levels under control.
  3. Get your BMI down: exercise regularly and keep your BMI below 30. Obesity is a serious risk factor for peripheral arterial disease and keeping the weight off will go a long way towards preventing disease.
  4. Normalise blood pressure: avoid triggers that increase your blood pressure, whether they be dietary, stress or other. High blood pressure increases the risk for both heart disease and peripheral arterial disease.
  5. Lower cholesterol levels: high blood cholesterol levels increase the chances that fatty deposits will collect in narrowed arteries, making arteries even narrower and reducing the flow of blood to the legs and feet.

If you or a family member suffers from any of these symptoms, it is advisable to contact your Podiatrist or doctor to discuss and assess your situation. Please contact us for an appointment.

 

This information is based on materials supplied by the Australian Podiatry Association (SA).

People often present complaining of pain in the front of the foot around the third and fourth toes. One common condition responsible for this pain is a neuroma or Morton’s neuroma.  The following information should help to explain the how and why of a neuroma and what you can do to prevent and resolve this condition.

Signs and Symptoms

  • Tingling and/or pain between the third and fourth toes.
  • Cramping in the toes.
  • Numbness in the toes or on the ball of the foot.
  • Inflammation between the toes.
  • Pain is worse when walking or applying pressure to the area.
  • Severe sharp or burning pain in the ball of the foot and at the base of the toes.

Causes

  • Morton’s neuroma is caused by compression and irritation of the nerve between the third and fourth metatarsals.
  • Compression and trauma to the metatarsals can irritate and damage and thicken the nerve between the metatarsals.

Risk Factors

  • Sex: Women are more likely to suffer from neuroma than men due to increased forefoot loading through footwear.
  • Exercise: people who are active and regularly exercise are at an increased risk due to regular and persistent constriction of the nerve.
  • Pathology: people with existing biomechanical deformities such as pes planus, pes cavus, bunions or hammertoes, are at an increased risk of neuroma.
  • Inappropriate footwear: High heeled and tight fitting shoes will compress the metatarsals and increase the likelihood of developing neuroma.

Treatment

  • Avoid restrictive footwear that will irritate the nerve.
  • Massage can help to alleviate pain.
  • Patients with pre-existing foot complications such as flat feet, high arches, bunions or hammertoes are likely to find their symptoms for neuroma increased by their pre-existing conditions that cause restriction around the nerve. Prescription orthoses can be effective in alleviating the added stress caused by these conditions and thereby reducing and/or eliminating the pain of the neuroma.
  • Ultrasound guided injection of local anaesthetics and steroids have been shown to be effective in the management of neuroma symptoms.
  • In extreme cases, surgical removal of the thickened tissue around the nerve, or even removal of the nerve itself, can be necessary.

If you suffer from these symptoms and require an assessment or opinion from one of our trained Podiatrists, please contact us for an appointment.

 

This information has been provided by the Australasian Podiatry Association for it’s members.

Foot pain affects most people at some time or another and Podiatrists are specifically trained to assess and treat foot and leg problems using safe effective and painless techniques.

At PodSquared Podiatry we have structured our practice to care for your whole family. It doesn’t matter if you are just starting to walk, or have been walking and playing sport for decades, we are here to keep you and your family on your feet. We are passionate about foot health and continually update our education and techniques to provide our clients with the best possible advice and treatments.

We believe that your feet are the foundation of your body and that a strong postural foundation is essential to your health and wellbeing. As Podiatrists, we understand the underlying causes of foot pain and how chronic foot pain and injuries can prevent you from leading a full and active life.

At PodSquared, we look beyond the obvious symptoms of your foot condition to identify the structures and processes involved to treat the cause of your foot problems. Foot pain affects the function of the entire body, through a process of compensation that can lead to knee, hip and back pain.

Our experienced team of Podiatrists can work with you and your health care team to achieve the best possible outcomes.

Put your feet in our hands and experience the difference our service can make to your feet, health and mobility.

Appointments can be made by phoning 08 8363 4588.