From the Guidelines
The treatment algorithm for calcaneal apophysitis should begin with conservative management, including open-backed shoes, heel lifts or orthoses, NSAIDs, decreased activity, stretching exercises, and weight loss (if indicated), as these measures have been shown to be effective in managing symptoms and promoting recovery. The initial approach to managing calcaneal apophysitis involves a combination of non-pharmacological and pharmacological interventions. Key components include:
- Open-backed shoes to reduce pressure on the affected area
- Heel lifts or orthoses to provide support and cushioning
- NSAIDs for pain and inflammation management
- Decreased activity to avoid exacerbating the condition
- Stretching exercises to improve flexibility and reduce tension on the Achilles tendon
- Weight loss, if indicated, to reduce the strain on the calcaneus
According to the American College of Foot and Ankle Surgeons, as reported in the American Family Physician 1, these initial treatment options should be continued until symptoms resolve, provided there is improvement within six to eight weeks. It is also important to note that local injections of corticosteroids are not recommended due to potential adverse effects. In cases where symptoms persist or are severe, immobilization may be considered as a last resort. The goal of treatment is to manage pain, reduce inflammation, and promote recovery while avoiding further irritation to the calcaneal apophysis.
From the Research
Treatment Algorithm for Calcaneal Apophysitis
The treatment algorithm for calcaneal apophysitis involves various conservative management options, including:
- Ice, activity restriction, stretching, nonsteroidal anti-inflammatory drugs, immobilization, and heel cups 2
- Orthotic devices, such as heel raises or orthoses 3, 4
- Physical therapy, including eccentric exercise regimes under physiotherapeutic supervision 3
- Taping, heel lifts, and kinesiotherapy 4, 5
- Rest and avoidance of high-impact activities 6, 5
Effectiveness of Treatment Options
Studies have shown that various treatment modalities can be effective in reducing pain and improving outcomes in children with calcaneal apophysitis, including:
- A pragmatic wait and see protocol, a heel raise inlay, and an eccentric exercise regime under physiotherapeutic supervision, which all resulted in significant improvement of outcome measures 3
- Orthoses, which provided greater short-term pain relief than heel raises 4
- Conservative treatment options, including physical therapy and rest, kinesiotherapy and taping, and orthotic devices, which reported improved outcomes in 53.7% of cases 5
Considerations for Treatment
When treating calcaneal apophysitis, it is essential to consider the individual patient's needs and preferences, as well as the severity of their symptoms. Physicians should deliberate with patients and parents regarding the preferred treatment option 3. Additionally, educating parents and coaches about the symptomatology, etiology, and treatment of calcaneal apophysitis is crucial for early diagnosis and better outcomes 5.