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Question: Ortho

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You are seeing a 10 year old boy active in club soccer who comes in complaining of intermittent posterior heel pain, particularly after soccer games. He has pain at the posterior calcaneus, especially when the sides of the heel are squeezed. There is no history of trauma or fall. There are no other abnormal physical exam findings, and radiographs are normal. The patient is not limping and currently does not have pain at rest.

Which of the following managements is indicated at this time?

pemsou5_wp • May 21, 2019

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  1. Kelly May 22, 2019 - 11:34 pm Reply

    E) Conservative management with ibuprofen as needed and gel heel cup shoe inserts
    The patient described is typical of Sever’s disease, an apophysitis caused by the Achilles tendon pulling on its apophyseal insertion, much like in Osgood-Schlatter disease. Overuse can cause irritation and microtrauma to the area. Management is conservative, with rest when there is pain (but no need to stop all activity), NSAIDs as needed, stretching exercises for the heel cord complex and strengthening of calf muscles. Gel heel cups bought over the counter may relieve acute pain by lifting the heel and reducing tension on the Achilles tendon, but these are not curative. Some children active in sports need to plan with their coaches to play all their allotted quarters continuously – ie once they come off the field or court, the pain will set in and impede play. Severe symptoms may require referral to an orthopedist for a short period of immobilization and non-weight bearing, but this is rare.

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