What is the treatment for calcaneal apophysitis?

Treatment for Calcaneal Apophysitis

The most effective treatment for calcaneal apophysitis includes a combination of rest, heel raises or orthotic devices, regular stretching exercises, and pain management with ice and NSAIDs. 1, 2

Initial Management

Pain Management

• Apply ice through a wet towel for 10-minute periods (cryotherapy) to provide immediate pain relief 1
• Use non-steroidal anti-inflammatory drugs (NSAIDs) for short-term pain relief 1
• Alternative pain medications:
  • Paracetamol can be used as an alternative to NSAIDs 1
  • Celecoxib may be considered as a non-selective NSAID alternative 1

Activity Modification

• Reduce or modify activities that exacerbate heel pain
• Complete rest is not necessary, but high-impact activities should be limited until symptoms improve
• Return to sports activities can typically occur within 2 months with appropriate treatment 3

Orthotic Interventions

Heel Raises/Heel Cups

• Heel raises provide better short-term pain relief (within 1-2 months) compared to prefabricated orthoses 4
• Soft Plastizote orthotics or heel cups are effective in 98% of patients 3
• At 6 weeks, patients using heel raises report higher satisfaction levels compared to other treatment approaches 2

Custom or Prefabricated Orthoses

• Prefabricated orthoses can help redistribute pressure and correct biomechanical issues 1
• Long-term outcomes (at 12 months) show no significant difference between heel raises and prefabricated orthoses 4

Physical Therapy Interventions

Stretching Exercises

• Perform stretches 3-5 times daily, particularly:
  • Before getting out of bed
  • Before climbing stairs
  • Before going to sleep 1
• Hold stretches for 6-10 seconds, then slowly relax
• Rest 2-3 seconds between repetitions
• Never hold breath during exercises 1
• Focus on calf and plantar fascia stretching 1

Strengthening Exercises

• Ankle dorsiflexion strengthening exercises are beneficial 3
• Eccentric exercise regimes under physiotherapeutic supervision can be effective 2

Kinesiotherapy

• Kinesio taping can help restore ankle function in athletes with calcaneal apophysitis 5
• While kinesio taping shows benefits for functional improvement, its role in pain relief is limited 5

Footwear Modifications

• Ensure properly fitting footwear with adequate support 1
• Consider therapeutic footwear that demonstrates plantar pressure-relieving effects 1
• Advise patients to never walk barefoot, in socks only, or in thin-soled slippers 1
• Proper athletic footwear is essential, especially for sports participation 3

Treatment Algorithm

1. First-line treatment (0-6 weeks):

   • Pain management with ice and NSAIDs
   • Heel raises or orthotic devices
   • Daily stretching exercises
   • Appropriate footwear modifications

2. If no improvement after 6 weeks:

   • Consider referral to a foot specialist 1
   • Evaluate for underlying foot pathology or complicating factors
   • Consider physical therapy with supervised eccentric exercise program 2

3. Follow-up:

   • Evaluate response to treatment every 4-6 weeks 1
   • Most patients improve within 2 months with conservative treatment 3

Comparative Effectiveness

• A randomized clinical trial comparing wait-and-see approach, heel raise inlays, and physical therapy found that all three treatments resulted in significant improvement 2
• At 3-month follow-up, no clinically relevant differences were found between treatment modalities 2
• Treatment choice may defer to clinical judgment, cost considerations, and patient preference after 2 months 4

Common Pitfalls and Caveats

• Failure to address pronation, which is a common associated foot condition in 19% of patients 3
• Inadequate stretching protocol (frequency, technique)
• Inappropriate footwear, especially during sports activities
• Returning to high-impact activities too quickly
• Focusing only on pain management without addressing biomechanical factors

Remember that calcaneal apophysitis is self-limiting, but appropriate treatment can significantly reduce symptoms and allow earlier return to activities.