>Dear Gillian
You would need to consider Sever's Disease (calcaneal apophysitis).
It is a common overuse problem i.e. condition caused by unresolved
submaximal stress in previously normal tissue. Many stress-related
injuries ... are junctional problems, bone-muscle, muscle-tendon etc.
also referred to as non-articular osteochondrosis or a traction
apophysitis. The age is usually 9 - 12 yo and the children are active
in sport. Some other suggestions apart from your present management
are more swimming, ice-packs, shock-absorbing insoles, arch support
or a heel raise. I would also check for hip range of movement and
length of other two joint muscles (eg hamstrings). Involve the boy in
some self-knowledge (aggravating and easing factors) and give him
management strategies (eg ice, stretches etc) - prognosis should be
good, but see the orthopaedic surgeon if no improvement as he may
need a cast.
Reference : Stanitski et al 1994 "Paediatric & Adolescent Sports
Medicine" Philadelphia, WB Saunders.
Best wishes from Liz Williams
PS - remember Copenhagen!
At 11:05 PM +0200 2/4/00, gmarks wrote:
>Sun, 02 Apr 2000 23:05:02
Dear List
>
>Please could someone kindly advise on further management
>for a 10 year old boy with chronic bilateral achilles tendonitis.
>An active child, in swimming, tennis and rugby teams.
>The pain is situated mid tendon up to musculotendonous junction,
>and radiating down to tedon bone insertion when pain is severe.
>Most of his sport involvement has stopped due to the pain during,
>or, primarily the pain after playing sport.
>On palpation the tendon is slightly thickened.
>He has received treatment, in the form of ultra-sound, gastroc
>stretches (slow)
>and soleus
>stretches, (slow). Eccentric muscle control was worked on with body weight
>only.
>The pain remains, please could you give alternative managmemt ideas.
>With many thanks indeed.
>
>Sincerely Gillian MArks
Elizabeth Williams
Lecturer in Paediatrics
School of Physiotherapy
The University of Melbourne
Telephone + 61 3 9344 7924
Fax + 61 3 9344 4188
email [log in to unmask]
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