As a parent, you want your child to be as healthy and active as possible. However, there are times when growing pains and injuries can occur. Two common conditions that children may experience are Osgood Schlatters and Severs disease
Osgood Schlatter’s disease is a condition that affects the growth plate in the knee. It is most commonly seen in children and adolescents who are going through a growth spurt. The growth plate is an area of developing tissue at the end of long bones in children and adolescents. When bones grow quickly, the muscles and tendons around the bone may become tight, leading to increased tension at the site where the muscle attaches to the bone. This tension can cause inflammation and pain in the growth plate.
The bones of children and adolescents possess a special area where the bone is growing called the growth plate. Growth plates are areas of cartilage located near the ends of bones. When a child is fully grown, the growth plates harden into solid bone.
Some growth plates serve as attachment sites for tendons, the strong tissues that connect muscles to bones. A bony bump called the tibial tubercle covers the growth plate at the end of the tibia. The group of muscles in the front of the thigh (called the quadriceps) attaches to the tibial tubercle.
When a child is active, the quadriceps muscles pull on the patellar tendon which, in turn, pulls on the tibial tubercle. In some children, this repetitive traction on the tubercle leads to inflammation of the growth plate. The prominence, or bump, of the tibial tubercle may become very pronounced.
OSD usually develops during the stage of bone maturation (10-12 yrs in girls and 12-14 yrs in boys). The underlying etiology can be attributed to the repeated traction over the tubercle leading to microvascular tears, fractures, and inflammation; which then presents as swelling, pain, and tenderness.OSD is an overuse injury that mostly appears in active, adolescent patients. The repetitive strain and microtrauma results in irritation and in severe cases partial avulsion of the tibial tubercle apophysis. Rarely trauma may lead to a full avulsion fracture. Predisposing factors include poor flexibility of quadriceps and hamstrings or other evidence of extensor mechanism misalignment[3]. Severs disease, also known as calcaneal apophysitis, is a condition that affects the heel bone in children and adolescents. Like Osgood Schlatters, it is most commonly seen in children who are going through a growth spurt. The growth plate in the heel bone is particularly vulnerable to injury, as it is subjected to repeated stress from activities such as running and jumping. While both Osgood Schlatters and Severs disease are common in children and adolescents, they can be painful and debilitating if left untreated. If your child is experiencing symptoms of either condition, it is important to seek medical attention.
Cause
OSD usually develops during the stage of bone maturation (10-12 yrs in girls and 12-14 yrs in boys) . The underlying etiology can be attributed to the repeated traction over the tubercle leading to microvascular tears, fractures, and inflammation; which then presents as swelling, pain, and tenderness.
OSD is an overuse injury that mostly appears in active, adolescent patients. The repetitive strain and microtrauma results in irritation and in severe cases partial avulsion of the tibial tubercle apophysis. Rarely trauma may lead to a full avulsion fracture. Predisposing factors include poor flexibility of quadriceps and hamstrings or other evidence of extensor mechanism misalignment[3].
Severs disease, also known as calcaneal apophysitis, is a condition that affects the heel bone in children and adolescents. Like Osgood Schlatters, it is most commonly seen in children who are going through a growth spurt. The growth plate in the heel bone is particularly vulnerable to injury, as it is subjected to repeated stress from activities such as running and jumping.
While both Osgood Schlatters and Severs disease are common in children and adolescents, they can be painful and debilitating if left untreated. If your child is experiencing symptoms of either condition, it is important to seek medical attention.
Severs disease is a common growth plate problem affecting children of all backgrounds. It is also known as calcaneal apophysitis, which means inflammation of the growth plate in the back of your heel bone. Sever’s is common in children between the age of 7 and 14 years and can commonly occur during a growth spurt, when children grow quickly over a short time frame. As sports podiatrists, we often see children who are physically active, who complain of pain around the back of one or both heel bones. Their calf muscles are often tight and they may be involved in a minimum of 3 to 4 periods per week, of sport / physical activity. They may report pain that is present each morning when rising from bed, and an increase in symptoms from quick movement sports or activities that involve jumping.
Sever’s disease can be described as an out of synch growth pattern, whereby the calf bones grow quicker than the calf muscles / Achilles tendon.
During this growth spurt, your heel bone also grows more quickly than the calf muscles. As these bones grow faster than your muscles, your Achilles tendon that attaches the calf muscles to the back of the heel pulls hard on the heel bone, as it essentially becomes too short. The net result is an increased pull on your growth plate at the back of the heel. The growth plate of this heel bone (calcaneus) is cartilage that hast not ossified yet (developed into mature bone) and hence is a weak target for this increased pulling sensation. What ensues can be described as a traction injury which can be seen in association with inflammation and posterior / plantar heel pain. Severs disease can render your child inactive as they pull out of sporting activities.
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Symptoms
Symptoms of Osgood Schlatters disease include pain and swelling below the knee, which is aggravated by activities such as running, jumping, and squatting. The pain may be mild at first but can become more severe over time. In some cases, a bony bump may form below the knee, which can be visible and palpable. This bump is caused by the body’s attempt to heal the inflamed growth plate, and is usually not a cause for concern.
Symptoms of Severs disease include pain and tenderness in the heel, which is aggravated by activities such as running and jumping. The pain may be mild at first but can become more severe over time. In some cases, there may be swelling or redness around the heel. Children with Severs disease may also limp or walk on their toes to avoid putting pressure on the heel.
Typically, the pain at the back of the heel is worse after physical activity and improves with rest. Sever’s disease can affect one or both feet. Sever’s disease is slightly more common in boys than girls and usually affects children aged 8 – 12 years. It is uncommon in older teenagers as the heel bone usually finishes growing by age 15 years.
Treatment
Treatment for Osgood Schlatters and Severs disease typically involves a combination of rest, ice, compression, and elevation (known as the RICE method). This can help to reduce pain and inflammation in the affected area. In some cases, physical therapy may be recommended to help stretch and strengthen the muscles around the affected area.
In addition to RICE and physical therapy, there are a number of things that parents can do to help prevent Osgood Schlatters and Severs disease. These include:
Encouraging your child to stretch before and after physical activity. This can help to prevent muscle tightness and reduce the risk of injury.
Ensuring that your child wears proper footwear that is appropriate for the activity they are participating in. Shoes with good arch support and cushioning can help to reduce the impact on the feet and lower legs.
Limiting your child's participation in high-impact activities, such as jumping and running, if they are experiencing pain or discomfort.
Encouraging your child to participate in a variety of physical activities to reduce the risk of overuse injuries.
Providing your child with a balanced diet that is rich in nutrients such as calcium and vitamin D, which are essential for bone health.
Monitoring your child's growth and development, and seeking medical attention if you notice any unusual symptoms or changes.Reassure your child that the pain will go away in time. Seeing a physiotherapist can be helpful to learn ways to stretch the Achilles tendon and quadriceps and keep pain under control.
In conclusion, Osgood Schlatters and Severs disease are common conditions that can affect children and adolescents during periods of growth and development. While they can be painful and debilitating, they are usually treatable with a combination of rest, treatment, and graduated exercise.
If you have tried all these modalities and the pain persists contact us at Northwest Physiotherapy Group. We are an experienced team of musculoskeletal physiotherapists who will make a difference.
