Calcaneal apophysities is a bone disorder that causes inflammation of the growth plate in the heel. Although not a disease, it is also called Sever’s disease. During the development of the bone, cartilage cells change into bone cells, forming new bone at the growth plate. During the process, inflammation occurs in the growth plate, causing pain and swelling.
This condition occurs in children whose heel bones are still developing, around the ages 8 to 14. Most often an overuse condition, physically active kids are usually the ones at risk and more patients are reported to have both feet affected. From age 15 onwards, the bones are usually fully developed and unlikely to get this disorder.
When the heel bone grows faster than the leg muscles and tendons, they are overstretched. And with repeated stress on the growth plate due to physical activity, muscles are strained and tissue inflamed. Sports that require running and jumping such as basketball, soccer and track are common causes of calcaneal apophysities.
Ill-fitting shoes could also contribute to the condition. Without enough support or padding, the heel is constantly rubbing against the shoes or receiving the impact of the foot hitting against the ground, adding pressure to the heel.
Other reasons for this condition could be due to obesity, a tight Achilles tendon, flatfoot, high-arched foot or short leg syndrome.
The patient would feel pain in the back and/or bottom of the heel with redness, swelling and tenderness. When the sides of the heel are squeezed, a sharp pain is felt. During sports activities, the pain would worsen. Even while walking or standing, there would be discomfort and stiffness in the foot. To compensate, the child may limp or walk on toes.
If there are no other serious conditions, conservative treatment is usually used to relieve the symptoms of calcaneal apophysities. The patient has to reduce or stop all physical activities. Shoe inserts, heel lifts or orthotic devices are used to support and cushion the heel. Medications such as Nonsteroidal anti-flammatory drugs (NSAIDs) are prescribed to reduce the pain and inflammation.
For further reduction of inflammation, the child has to go through physical therapy that helps to stretch and exercise the calf muscles and Achilles tendons. If the symptoms are very severe, the foot may have to be immobilized in a cast or brace to completely remove weight bearing and hold the heel in position to allow healing.
Calcaneus fractures, or heel bones fractures, is the most common of fractures of the tarsal bone. Tarsal bone fractures account for 2% of all adult fractures and of those, 60% are calcaneus fractures.
Usually caused by a high-impact collision on the calcaneus, this type of fracture is most often incurred from jumping or falling from a great height or motor vehicle accidents. Patients with osteoporosis are also at greater risk for this fracture as their bones have lower mineral density and thus more brittle.
Patients with diabetes are more susceptible to fractures and have a high risk for infection and healing complications that might lead to limp amputation. It is important to let your doctor know about your full health condition beforehand.
Fracture patients would experience pain, bruising, swelling, heel deformity and may be unable to walk. Even if pain is tolerated, patient would walk with a limp as the muscle and tendon is not strong enough to fully support the weight. The intensity of the symptoms depends on the severity of the damage.
Types of treatment
There are a few considerations your doctor put into deciding your course of treatment. It depends on the severity of the fracture, the cause of injury and whether your health condition allows you to respond well to the treatment.
Usually surgery is needed to put the bones back together except for mild cases of cracked bones. Different treatments are used for the different types of fractures:
- Stable fracture
The broken ends of the bones are still correctly aligned. No surgery is needed. The leg is immobilized in a cast to allow the bones to heal.
- Display fracture
The bones are displaced and not aligned. The pieces are put back together with surgery. Your doctor may recommend waiting till the swelling has gone down before going through surgery to reduce the risk of infection. This is done by immobilizing the leg and elevating it for a few days.
- Open fracture
The bones are broken through the skin and usually damage the muscles, tendons and ligaments. Immediate surgery is required as the wound is open and exposed to the environment.
- Closed fracture
This is a closed wound and the skin is not broken. However, internal soft tissues may be badly damaged.
- Comminuted fracture
The bones are shattered into several pieces and the damage is severe. Caused by a great impact like a head-on car collision.
- Percutaneous Screw Fixation
Small incisions are made to place screws in to hold the bones together. This procedure only viable if the broken bones are still in large pieces and can be pulled back into alignment.
- Open Reduction and Internal Fixation
The bone fragments are pieced back in place and held together with screws and metal plates.
For nonsurgical treatment, the injury can recover in 6-8 weeks. Surgical treatments take longer to recover. It might require 3-4 months before normal activities can be resumed. Severe fractures might even take up to 1-2 years before full recovery is achieved.
If pressure is applied on the injury during the healing process, it might further aggravate it and the screws might break, causing the bones to collapse. This causes serious repercussions and it would be even harder to fully recover.
Extracorporeal shock wave therapy or more commonly known as Shockwave therapy is a non invasive medical treatment that sends acoustic waves to injured parts of the body with the intent to reduce pain and promote healing. The shockwaves used for Shockwave therapy is similar to those used to break down kidney stone, but it is only at one tenth of the intensity, rendering it rather safe for the body. There are many uses of shockwave therapy and it can be widely applied to treat different injuries. Let’s take a look at some of the common applications of Shockwave Therapy.
Shockwave therapy promotes hyperaemia which is actually the increase in blood flow to a targeted part of the body. Hyperaemia is the basis of shockwave therapy and the increase in blood flow provides extra energy and loosens up the muscles and path interactions between the actin and myosin. This will reduce muscle tension and decrease pain.
Dispersion of substance P
Substance P is a neuropeptide in the body and it functions as a transmitter and modulator for nerve communication. The main purpose of substance P is to modulate inflammation. Shockwave therapy can efficiently disperse substance P and increase the secretion of histamine. Dispersion of substance P also helps to reduce pain in the affected area and reduce the risk of developing oedema or fluid retention.
Increases collagen production
Collagen is the main protein that is found in the connective tissues throughout the body. It works together with elastin to provide structure and flexibility to the skin. Collagen is also the pre-requisite for any repair mechanism in the body that is due to a damaged ligament structure. Shockwave therapy will help to stimulate collagen production in the deeper layers of the tissues and this is something that you can never achieve just by taking collagen supplements.
Shockwave therapy removes nociceptive metabolites and helps to increase oxygen levels in the body and increasing the energy source. It also helps to reduce histamine which is acidic and increases the metabolism rate in the body.
Shockwave therapy will over stimulate nerves that are responsible for the transmission of pain to the brain, reducing pain immediately. It will also trigger the healing mechanism of the body and increases the formation of blood vessels in the affected area, speeding up the recovery process.
Shockwave therapy is a non-invasive treatment method that can be used for treating soft tissue injuries. Since it is non-invasive, there is minimal downtime and a hospital stay is not required. However, shockwave therapy may be painful for some but it is otherwise tolerable.
Dancing is a physical activity that is accompanied with a certain level or risk. Dancing is something that needs to be gradually built up from scratch and one cannot simply jump into it expecting to do something they have never tried. Proper warm up and stretching as well as cooling down exercises will need to be performed religiously before and after every session. Injuries can be career threatening to any dancer and it is important to take precautions to prevent them from happening.
Meniscus Knee Tear
Dancing requires a lot of jumping and knee twisting actions accompanied by sudden direction changes. This will place a lot of stresses on the knee, particularly the ligaments and meniscus. A tear in the knee meniscus is one of the most frequent injuries experienced by dancers and it can put you out of action for up to 6 months depending on the severity. It is important to strengthen the leg muscles particularly the knee, thigh and calf to help reduce the burden on the knee.
A proper ankle connection is important in dancing. Ankle sprains occur when upon landing from a jump, the outside of the ankle rolls inwards due to a loss of balance. This will cause the ligaments in the ankle to tear. Ankle sprains are painful and will hinder you in many aspects of your daily life. You will be out of action for up to a month.
Achilles tendonitis is tendonitis of the Achilles tendon and it occurs due to muscle overuse after repeatedly acting pressure on the calf muscle. It happens most frequently in dancers who place a lot of their weight on the lower body.
Neck strain is a common injury and it happens so frequently because dancers have to move their head throughout a dance and many of them control it incorrectly. Instead of using the spine when they arch their neck, they use the tendons, overusing them.
Dance practices and rehearsals can sometimes take a long time and start from early in the morning till late at night. As a result, they are easy victims to muscle cramps due to fatigue and a lack of required electrolytes to replace the ones they lost throughout the day. Sometimes it can happen due to improper warm up exercises.
Dancing is a very physical demanding activity and the risk of injuries is high. New dancers will need to start slow while experienced dancers cannot be complacent and skip the basic warm up and cooling down exercises. Dancers will also need to ensure that they replace their lost fluid to prevent muscle cramps.
Heel pain is a very common problem experienced by many and is caused by different reasons. Patients will often suffer pain under the heel or behind the heel. Most of the time, heel pain will disappear on its own with time but in serious cases, they can become chronic problems. There are 26 bones in the human foot and the largest bone is the heel bone. The function of the heel is to provide support and balance the weight of the body. With such immense weight acting on it and various activities such as running and jumping, the heel is at a high risk of injury.
Plantar fasciitis is a painful result of the inflammation of the plantar fascia. The plantar fascia links the heel bones to the toes and is responsible for the arch of the boot. Plantar fasciitis can cause immense pain which increases with every additional step you take but once you warm up the leg, the pain will start to go away, coming back again after periods of immobility.
As mentioned above, the heel bone is the largest bone in the human foot and stress fractures can occur due to overuse of the heel. Continuous activity on a hard surface can also contribute to stress fractures due to the higher force environment. When the heel bone fractures under stress, it will cause immense pain at the heel region and recovery time is often lengthy.
Heel bursitis results from inflammation of the bursa which is located at the back of the heel. It is most commonly occurred when the patient lands on the heels incorrectly, injuring the tendons and bursa. Improper footwear may also contribute to heel bursitis. The pain will normally get worse as the day passes.
Tarsal Tunnel Syndrome
The Tarsal tunnel is located between the bones in the foot and the fibrous tissues in spaces. There is a nerve located at the tarsal tunnel called the posterior tibial nerve and it is protected by bones and tendons. Sudden high impact can cause stress fractures which will result in the posterior tibial nerve being pinched onto, causing pain at the heel and numbness at the region.
Heel pad inflammation
Located under the heel bone is the corpus adiposum which acts as a shock absorber to protect the heel bone. After repeated hard landings on the foot or overuse, inflammation of the corpus adiposum can occur, causing pain and discomfort. In more serious cases, haemorrhaging of the heel pad can happen. At times, simple activities like walking can also be a difficult task.
There are many different causes of heel pain and most of it is caused by overuse and lack of sufficient rest periods. The heel bone is an important part of our body and heel bone pain can restrict us from carrying out daily activities smoothly.
Many people around the world participate in martial arts. There are 3 types of martial arts namely the light, medium and full contact martial arts and as the names suggest, each differs in the amount of body contact involved. Martial arts have many benefits to it, most prominently are the health benefits as well as the coordination between various parts of the body, body balance and flexibility. However, as with all kinds of full contact sports, there are injuries that are associated with it.
Facial lacerations are the most common injuries sustained from full contact martial arts. They account for nearly 50% of all injuries in martial arts. Martial arts is all about predicting what your opponent will do next and if you fail to react accordingly, it can cause trauma to parts of your body, commonly the face. The result of a full blown kick to the face can cause facial laceration.
During martial arts, tremendous stress is placed upon both of the knees and kicking is required throughout the whole session. As such, it can cause hypertension of the knee joint which will result to tendinitis. It can create strain to the back of the knees, patellar tendons and patella, causing pain and discomfort in players.
Ankle sprains are also a common injury in martial arts due to the nature of uneven surfaces that the event take place. Most venues will place gym mattresses or other soft cushioning materials to absorb the impact of players. However, these soft and uneven surfaces can lead to improper weight distribution when kicking, causing sprains in the ankles.
Kneecap dislocation is a serious injury that happens when the patella is shifted out of alignment with the knee. It is often caused by improper leg alignment or sudden kneeling motion, causing a sudden trauma to the knee.
Whenever our feet is in use, the connective tissue or plantar fascia which supports the arch of our foot will tighten and stretch. However, it is prone to overuse if the incorrect footwear is worn. It is especially common in people with flat feet and who do not use the correct footwear with the correct support.
Martial arts have a low risk of injury as compared to other full contact sports such as rugby. Most of the injuries that are suffered are often minor such as bruises. However, more serious injuries can happen either due to trauma or due to improper usage of protective equipment or total lack of them. Upon injury, for personal well-being, it is highly recommended to pursue professional diagnosis for the injury. It should be regardless of perceived severity as most injuries do not reveal the actual impact until years later or when there is severe pain. If the martial artist is serious about his practice, then all injuries should be treated at earliest time possible.