Cheatography
https://cheatography.com
Hx, presentation, DDx, imaging, management
This is a draft cheat sheet. It is a work in progress and is not finished yet.
Introduction
- Painful inflammation of the cartilaginous growth at the site of the calceaneal tendon insertion |
- Children most likely to suffer from this due to the growth plate being 2-5 times weaker than in adults |
- Bone lengthens rapidly, soft tissues become tighter, produces strain on bony attachments |
- Calcaneal apophysis subjected to significant shear loads because of its vertical orientation and direction of pull from the gastrocsoleus |
- Commonly found in athletically active populations aged 8-14 |
- Higher incidence in males |
- Can present bilaterally |
Presentation
- Progressive posterior heel pain |
- Worse with activity (usually limps) |
- Better with rest |
- Pain upon palpation of achilles insertion and squeeze test (squeezing medial and lateral calcaneus) |
- Mild swelling might be present |
- Active plantar flexion and toe raises and passive dorsiflexion can be uncomfortable |
- Looks for gastro-soleus weakness, joint hypomobility, poor lower extremity biomechanics (excessive foot pronation), inappropriate or excessive training, improper footwear, running on hard surfaces and excessive weight |
Imaging
- Rule out f#, neoplasm, osteomyelitis, bone cysts, foreign bodies (ongoing pain, pain at rest, pain that wakes patient up, significant swelling, fever, constitutional symptoms, significant loss of subtalar motion |
- Can impact ADLs if left untreated |
Management
- Ice (Pre and post sports) |
- NSAIDs |
- Myofascial release/stretching of calves |
- Orthotics (1/2 inch heel lifts - eases shear on calves) |
- Reduce frequency and intensity of exercise, limitation of running and jumping, cycling and swimming |
- Reassurance |
- When squeeze test is not painful - strengthen foot stabilisers and calves |
- Usually resolves within 2-8 weeks, if severe consider and CAM walking brace for 2-3 weeks |
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