Sever's disease typically occurs in children between 8 and 15 years of age and is a common condition affecting the bone of their heel. (1–3). Another name for this disease is calcaneal apophysitis. It frequently presents itself in children who are athletic and physically active. The development of heel bone, also known as calcaneus is not fully complete in children who are of growing age (8 to 15 years) (4). Until maturity, new bone keeps developing at the growth plate, also known as the physis. It is a weak area that is present behind the heel. During physical activity repetitive stress is placed on the growth plate which results in inflammation. (1,5–7).

INCIDENCE

This condition affects adolescents and energetic children who are growing rapidly due to puberty or they are starting a sports season, for example, basketball, gymnastics, or football (8,9). Most commonly, the disease affects during the starting days of the growth spurt. The ratio of disease presenting in boys to girls is 2-3:1 (8). The disease begins affecting growing children and continues after puberty, typically manifesting as Achilles tendonitis or plantar fasciitis in adults (1).

SIGNS

Common signs and symptoms include pain in the heel especially worse during and after physical activity. Usually, pain is absent in the morning and gets better after rest. When the back of the heel is squeezed, tenderness can be felt. There may also be swelling, irritation, redness, and warmth as well (10,11).

PHYSICAL EXAM FINDINGS

Tenderness can be felt when the heel is gently pressed. When the child is asked to stand on the toes, it typically increases the pain (10,11). Radiographic evaluation is usually performed to rule out any fractures, and typically will show an open growth plate at the calcaneus.

TREATMENT

Sever's disease affects many children and studies have shown that stretching is the best way to cure this problem. There are two types of stretching: static and dynamic. Dynamic stretching is what is typically performed before gym/sports and helps loosen the joints. Static stretching is what is necessary for treatment of Sever's disease, because it actually stretches the calf and hamstrings muscles which results in less pull on the growth plate. When growth plates are fully developed and closed, the disease can sometimes resolve, or may turn into Achilles tendonitis or plantar fasciitis. In that case, the treatment is the same. Tylenol and ibuprofen may be helpful in short term situations, however should not be overused especially in the pediatric population. In many cases, physical therapy may also be beneficial (12), and outcomes may be improved as much as 90% compared to stretching at home.

Pediatric equinus is broadly defined as generalized limited dorsiflexion at the ankle joint. It may result from either congenital or acquired causes and exhibit varying characteristics such as flexible, rigid, or spastic types. It has been extensively studied in literature and is known to be associated with the pathological condition of the bone, soft tissue, or combined deformity. In children, rigid plantarflexed cases can be debilitating and prevent them from ambulating without pain, if at all. As this volume in Clinics has chapters on comprehensive pediatric examination and neuromuscular disorders, this article will focus on (non-neurologic equinus) and its treatment via conservative and surgical methods with an emphasis on gradual correction.

Ankle sprains are common injuries in children and adolescents, especially during physical activities or sports. They occur when the ligaments that support the ankle joint are stretched or torn due to sudden twisting or turning of the foot (1,2). Ankle sprains can be classified into three grades based on severity: Grade I (mild), Grade II (moderate), and Grade III (severe) (3).

INCIDENCE

Ankle sprains are among the most common musculoskeletal injuries in pediatric and adolescent populations, accounting for approximately 30% of all sports-related injuries in this age group (4,5). They are more frequent in adolescents, with an increased risk during periods of rapid growth and development (6).

SIGNS AND SYMPTOMS

Common signs and symptoms of an ankle sprain include pain, swelling, bruising, and difficulty moving the ankle or bearing weight on the affected leg (1,2). The severity of the symptoms depends on the grade of the sprain, with Grade III sprains often causing the most pain and instability (3).

DIAGNOSIS

A thorough physical examination and patient history are essential for diagnosing an ankle sprain. Imaging studies, such as X-rays, may be used to rule out fractures or other injuries. In some cases, an MRI or ultrasound may be necessary to evaluate the extent of the ligament damage (7).

TREATMENT

Treatment for ankle sprains in pediatric patients typically involves a combination of rest, ice, compression, and elevation (RICE) to reduce pain and swelling (1,2). Nonsteroidal anti-inflammatory drugs (NSAIDs) may be used for pain relief, and in some cases, a brace or splint may be recommended to provide support and stability during the healing process (8). Physical therapy may also be beneficial in helping patients regain strength, flexibility, and balance (9). In severe cases or if conservative treatments are not effective, surgical intervention may be necessary (10).

Minimally invasive bunion surgery is a modern surgical approach to treat bunions, which involves smaller incisions and less disruption to the surrounding tissues.

Procedure

• Small incisions are made near the bunion
• Bunion is corrected using specialized instruments
• Minimal disruption to the surrounding tissues

Advantages

Benefits include less pain, quicker recovery, and reduced scarring compared to traditional bunion surgery.

Recovery

Patient recovery may involve limited walking and specific rehabilitation exercises. Recovery time varies based on individual cases.

Risks and Considerations

As with any surgery, there are potential risks, including infection, nerve damage, or recurrence of the bunion. Consultation with a healthcare provider is essential.