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Severs Disease Physical Therapy

Overview


Heel pain in children and adolescence: is the most common osteochondrosis (disease that affects the bone growth). Osteochondrosis is seen only in children and teens whose bones are still growing of the foot. Sever's disease or Apophysitis is a common condition that afflicts children usually between the ages of 8 to 15 years old. Often this is confused with plantar fasciitis which is rare in children. This is a condition of inflammation of the heel's growth plates.


Causes


Sever?s disease is caused by repetitive tension and/or pressure on the growth center of the heel. Running and jumping place a large amount of pressure on the heels and can cause pain. Children with Sever?s may limp or have an altered gait due to the pain. Risk factors for Sever's include tight calf muscles, weak ankle muscles, and alignment abnormalities at the foot and ankle. Sever?s can also result from wearing shoes without sufficient heel padding or arch support.


Symptoms


The main symptom of sever's disease is pain and tenderness at the back of the heel which is made worse with physical activity. Tenderness will be felt especially if you press in or give the back of the heel a squeeze from the sides. There may be a lump over the painful area. Another sign is tight calf muscles resulting with reduced range of motion at the ankle. Pain may go away after a period of rest from sporting activities only to return when the young person goes back to training.


Diagnosis


Sever's disease is based on the symptoms reported. To confirm the diagnosis, the clinician will examine the heels and ask about the child's activity level and participation in sports. They may also squeeze the back part of the heel from both sides at the same time to see if doing so causes pain and also ask the child to stand on tiptoes to see if that position causes pain. There may be tightness in the calf muscle, which contributes to tension on the heel. Symptoms are usually worse during or after activity and get better with rest. X-rays generally are not that helpful in diagnosing Sever's disease, but they may be ordered to rule out other problems, such as fractures. Sever's disease cannot be seen on an X-ray.


Non Surgical Treatment


Treatment is primarily supportive, with rest, pain management, and activity modification. Activity modifications include the addition of low-impact activities. Gel heel cups are sold over the counter and can be used intermittently to help reduce shock in the heel, as well as take tension off of the tight Achilles?s tendon complex. Proper stretching and strengthening activities should be preformed routinely even during periods of no pain. A large study showed that approximately 85% of children affected by Sever?s disease return to full activity within a two-month time period after starting treatment.


Surgical Treatment


The surgeon may select one or more of the following options to treat calcaneal apophysitis. Reduce activity. The child needs to reduce or stop any activity that causes pain. Support the heel. Temporary shoe inserts or custom orthotic devices may provide support for the heel. Medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, help reduce the pain and inflammation. Physical therapy. Stretching or physical therapy modalities are sometimes used to promote healing of the inflamed issue. Immobilization. In some severe cases of pediatric heel pain, a cast may be used to promote healing while keeping the foot and ankle totally immobile. Often heel pain in children returns after it has been treated because the heel bone is still growing. Recurrence of heel pain may be a sign of calcaneal apophysitis, or it may indicate a different problem. If your child has a repeat bout of heel pain, be sure to make an appointment with your foot and ankle surgeon.
02:32:19 . 19 Mayo 2015
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