From the Guidelines
The treatment for calcaneal apophysitis should begin with rest from painful activities, particularly high-impact sports, for 2-4 weeks, and initial management includes ice application, over-the-counter NSAIDs, and heel cups or orthotics to reduce tension on the Achilles tendon, as recommended by the American College of Foot and Ankle Surgeons 1. The goal of treatment is to reduce inflammation and maintain flexibility and strength until the growth plate closes. Key components of the treatment algorithm include:
- Rest from painful activities for 2-4 weeks
- Ice application for 15-20 minutes several times daily
- Over-the-counter NSAIDs like ibuprofen (400-600mg three times daily for adolescents, with appropriate weight-based dosing for younger children) for pain and inflammation
- Heel cups or orthotics to reduce tension on the Achilles tendon After the acute pain subsides, a structured rehabilitation program should be implemented, focusing on:
- Calf stretching (3 sets of 30-second holds, 2-3 times daily)
- Achilles tendon stretching
- Gradual strengthening exercises The return to sport timeline typically follows a progressive approach:
- Pain-free walking (usually 2-4 weeks)
- Low-impact activities like swimming or cycling
- Sport-specific training at reduced intensity (around 4-6 weeks)
- Full return to sport generally possible within 6-8 weeks if the athlete remains pain-free, as supported by the American Family Physician guidelines 1. It is essential to note that local injections of corticosteroids are not recommended, and immobilization may be considered in particularly acute or refractory cases, as stated in the American College of Foot and Ankle Surgeons' diagnosis and treatment of heel pain guidelines 1.
From the Research
Treatment Algorithm for Calcaneal Apophysitis
The treatment algorithm for calcaneal apophysitis typically involves conservative management, with the goal of reducing pain and maintaining physical activity. The following treatment options have been studied:
- Wait and see approach: This approach involves monitoring the patient's symptoms and providing education on pain management and activity modification 2.
- Orthotic devices: The use of orthotic devices, such as heel raises or foot orthoses, has been shown to provide short-term pain relief and improve function 3, 4.
- Physical therapy: Physical therapy, including exercises and stretching, can help to improve symptoms and maintain physical activity 2, 4.
- Kinesio taping: Kinesio taping has been used as a treatment option for calcaneal apophysitis, although its effectiveness is not well established 4.
Timeline for Return to Sport
The timeline for return to sport after treatment for calcaneal apophysitis is not well established, but it is generally recommended that patients gradually return to activity after symptoms have resolved. The following guidelines can be used:
- Initial treatment phase (0-6 weeks): Patients should avoid activities that aggravate symptoms and focus on pain management and rehabilitation 2.
- Intermediate phase (6-12 weeks): Patients can gradually return to activity, starting with low-impact exercises and progressing to more intense activities 4.
- Advanced phase (3-6 months): Patients can return to full activity, including sports, after symptoms have resolved and function has been restored 5.
Factors Influencing Treatment Outcome
Several factors can influence treatment outcome for calcaneal apophysitis, including:
- Age: Patients between 8-15 years old are most commonly affected by calcaneal apophysitis 2, 3.
- Severity of symptoms: Patients with more severe symptoms may require more intensive treatment and longer recovery times 2.
- Treatment adherence: Patients who adhere to treatment recommendations are more likely to experience improved outcomes 4.
- Activity level: Patients who participate in high-impact activities, such as sports, may be more likely to experience recurrence of symptoms 5.