Children’s skeletal growth occurs at the growth plate or apophysis.Typically, the apophysis remains “open” and growth continues for girls until age 13-15 and boys 16-18. For a year or 2 before growth plate “closure” that child will experience maximal growth velocity. 2 large tendons–the patellar tendon in the knee and the Achilles tendon in the heel–insert into the growth plates of the respective bones below that joint (tibia for knee and calcaneus for heel).
During that period of maximal skeletal growth those tendons are actually sliding along the bone at the site of the growth plate over time as it lengthens. This is necessary so that the tendon remains in proper anatomic position as the bone elongates. Specifically, as the tibia grows longer at the top, the patellar tendon slides upwards and as the foot grows longer at the calcaneus(heel) the Achilles tendon will slide backwards. Microscopically, this occurs as the fibers on one side of the tendon tear free and new ones grow and attach on the other side so that the tendon grows/moves in the same direction as bone growth. This process at the growth plate (apophysis) during accelerated growth in adolescents can cause inflammation and pain at the site called apophysitis. Knee pain apophysitis is called Osgood Schlatter’s disease and at the heel it is called Sever’s disease (I’m still not sure if “Sever” should be pronounced as rhyming with “weaver” or “weather,”, but anyway). The pre-teen or teen will complain of chronic pain that is worsened by running, jumping, or climbing stairs. The only finding in OS may be a painful red lump below the kneecap, affects about 20% of athletes, and in about 25% will be bilateral. In Sever’s the child will have tenderness on the inside and outside of the heel, has a 2-3:1 male;female ratio and may be bilateral up to 60% of the time.
Both conditions are usually self limited in that they will resolve when the child achieves adult height and the growth plates close. For both conditions, usual treatment consists of proper stretching before activity and ice the affected area afterwards. Ibuprofen is good for pain avoid caffeinated beverages on ibuprofen); padded knee pad for OS and cushioned shoe soul inserts for Sever–either “off the rack” or custom made orthotics by a podiatrist are often helpful as well.
Many children can “play through the pain.” Some may choose a period of rest, or changing sports to relieve pain (swimmers don’t have these problems). Both of these conditions tend to be mild, uncomfortable inconveniences as opposed to more serious threats to a child’s wellbeing, but either can rarely be more serious requiring specialists management(orthopedist or podiatrist). Of course, not all knee or heel pain is apophysitis. So, if your child is experiencing these problems, give me a call and we can check it out together.
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