Contributing factors in children who present with calcaneal apophysitis

Abstract

Introduction: Calcaneal apophysitis is a condition presenting in children between the ages of 8-15 years and is one of mostcommon lower limb sporting presentations in older children. It is thought be an inflammation and/or tractional condition at the apophysis of the heel however there is limited research confirming causative factors. The purpose of this study was to identify any association between activity levels, anthropometrics and quality of life impacts in children who present with pain associated with calcaneal apophysitis. Methods: Children were eligible for participation if they had pain on medial and lateral compression of the calcaneal apophysis, no history of trauma or systemic illness.Children between the ages of 8-15 (n = 124) diagnosed with calcaneal apophysitis were assessed with the following: • BMI (kg/m2) • FPI-6 • Weight bearing lunge test (WBL) • Oxford Foot and Ankle Questionnaire • The Footwear Assessment Tool • Activity levels measure by the Children's Leisure Activities Study Survey Results: The baseline measures were collected from 124 symptomatic children (males = 72, mean age 10.88 (+1.48) years). When compared to population norms, symptomatic children had a higher BMI (p = <0.001) and were taller (p = <0.001). Multiple regression analysis determined that these children were more likely to experience more pain throughout the day the older they were (p = 0.05) and the longer they had symptoms (p = 0.02). Pain was also associated with a decrease in interaction with peers and in social and school activities (p = <0.001). Increased participation levels in organized physical activity were associated with an increased ankle range of motion (straight leg WBL, p = 0.004, bent knee WBL p = 0.01) and the shoes most commonly worn (dual density athletic footwear p = 0.006). There was no association between any factors with inactivity. Discussion: This study is the first to examine how this pain impacts their participation in the school environment and the progression of pain as they aged. Our results indicate an association between ankle dorsiflexion range and degree of participation in physical activity, suggesting that traction on the apophysis may be an important contributor to reduced activity associated with this condition. Our finding that physical activity levels were higher if the most commonly worn footwear was a dual density cushioned footwear may also indicate that impact forces mediate the association between calcaneal apophysitis and physical activity. Clinicians should consider both the biomechanical factors and the impact forces when considering their treatment pathway to ensure physical activity is maintained.