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Calcaneal Apophysitis

Calcaneal apophysitis is a condition that typically occurs to boys and girls between the ages of 8 and 16, although it can occur during any growth spurts and until growing stops. 

It is frequently mistaken for plantar fasciitis, however it is very different in it's management. 

Please note that this page is provided for information only. We do not treat children under 18; however, should you - as a parent or guardian who is over 18 - wish to have a consultation to discuss management strategies, then this may be organised. Please email the office: office@keeponyourfeet.co.uk

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A side-on x-ray view of a foot

About Calcaneal Apophysitis

The heel bone is known as the 'calcaneus' and the 'apophysis' is the proper name for growth plates in bones; 'itis' simply means inflammation, so calcaneal apophysitis is inflammation of the growth plate in the heel. 

It typically occurs during growth spurts and can be exceptionally painful for children experiencing it. 

The good news is that, although it can be painful, there are some good management strategies that can be put in place to help manage the pain. Likewise, the pain will settle when the growth spurt has finished, it just requires a little patience. 

Symptoms that make it unlikely to be calcaneal apophysitis:

There are some symptoms which, if they are being experienced, mean you should take your child to a doctor:

  • Pain which (ordinary) pain killers does not relieve

  • Pain at night or while inactive

    • In particular when the pain is more severe than the previous days activities allowed​

  • Recent unexplained weight loss​

  • Night fevers

  • Night sweats

    • (to the point that it seems they have wet the bed)

  • Night terrors

A side on X-ray view of a foot with a broken heel bone. This type of fracture is known as a casa nova fracture
An x-ray of a healthy child's foot. The x-ray demonstrates that a healthy child's foot contains growth plates, which can look like fractures.

What else could it be?

There are over 40 common conditions that have the 'heel pain' symptom. Common ones are:

  • Plantar fasciitis

  • Achilles tendinitis

  • Calcaneal oedema

  • Panniculitis

However, in children under 16, if they are in the middle of a growth spurt, it is most likely to be calcanal apophysitis.

How is calcaneal apophysitis diagnosed?

Clinical examination and a thorough history is often adequate, however, in some instances it can be useful to use imaging to

  • Confirm the diagnosis

  • Identify how severe the problem is

  • Rule out other problems.

It is only in exceptional circumstances that a health professional would order imaging for calcaneal apophysitis.

Another part of how calcaneal apophysitis is diagnosed is through seeing how your child responds to treatment. If they fail to respond positively to treatment, then further diagnostic intervention may be necessary.

A doctor doing an ultrasound scan on the back of a person's heel.
A person standing up on their tip toes as an exercise for foot pain.

How is Calcaneal Apophysitis treated?

Calcaneal Apophysitis is a condition which requires a careful balance of rest to reduce the inflammation, but activity in order to encourage good (and strong) bone healing. Likewise, as calcaneal apophysitis occurs during childhood, allowing your child to take part in activities as much as they can tolerate can be really important for their social development.

  • Rest

  • Anti-inflammatories

  • Shockwave therapy

  • Heel raises (and occasionally orthotics)

  • Taping

  • Padding

  • Cushioned and supportive footwear.

How long does it take to cure calcaneal apophysitis?

Calcaneal apophysitis, due to the fact it is closely linked to the growth spurts of your child, lacks an element of predictability. 

This being said, there are a few points to take away:

  • The advice you receive for the first episode will be similar for future episodes

  • If future episodes fail to respond well to the treatments, you should bring your child to a clinician to have them check the diagnosis is correct

  • It is important to encourage them to take part in 'mandatory' activities (school sports, for example) over 'fun' activities (playtime); as otherwise schools can be less forgiving. 

  • It is important to provide cushioning for their feet where possible, so having a pair of trainers or crocs for them to pad around the house in can be super helpful.

Lady running with her dog
Ready to say goodbye to your pain?

At Keep On Your Feet, we openly acknowledge that we cannot guarantee a cure for things: but we will work as hard as we can with you to help you reach your goals. 

As stated at the top, at Keep On Your Feet, we currently do not treat under-18s. This being said, we are happy to have an appointment with you as parents to discuss your options and management strategies.

This is a picture of Jeremy Ousey, director and podiatrist of Keep On Your Feet.

About the Author

Jeremy Ousey is the owner at Swansea's podiatry clinic: Keep On Your Feet. All the information found on this page was written by him (there's no AI or Chat-GPT here!), and has been carefully chosen to provide you with the information that you need to know about the condition. Jeremy has a Bachelor of Science in Podiatry, with honours, a Post-Graduate Certificate in Podiatric Sports Medicine, a Post-Graduate Diploma in Medical Ultrasound, and two Master's of Science degrees in the Theory of Podiatric Surgery, and Sports & Exercise Medicine. If you would like to know more about Jeremy, please click here.

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