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Sever osteochondrosis pathology or growth

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Sever osteochondrosis pathology or growth
Thomas, a 10 year old complained since the school year of pain sitting at the heels, usually right, and sometimes a very high intensity.
This young boy practice for two years now, regularly in the tennis club and often participates in tournaments.
He plays on clay and has so far had no foot problem, and no previous trauma.
Forcing Thomas consulted today is that lately he feels a pain not only effort, but also walking and especially for two weeks, he can no longer play tennis, the pain is too vivid.
On physical examination, we ask Thomas if this pain is new or if he remembers having already been some signs of suffering.
The answer is often "yes" but for fear of a judgment of his favorite sport, he has not seen fit to tell his parents.
The review reveals a very exquisite pain at the lateral pressure on the posterior edge / bottom of the calcaneus (heel), which in most cases requires on the part of the child to withdraw his foot.
There is also sometimes a pain under the heel by impaction of the palm of the hand on the calcaneus.
Sometimes the child may feel pain in the Achilles tendon at the bottom near its insertion.
We have no visual sign on both the heel but also on the whole foot.
But no doubt, the age of the child, intensity, and location make us think without hesitation pathology SEVER.
This is a pathology of growth part growth osteochondroses up for this case the posterior process of the calcaneus (heel).
The practice of sports such as football, tennis, handball ... promotes the impact of the heel on the floor the appearance of this disease causing alteration of the secondary ossification nucleus.
We find this condition more often in boys, and in an age between 8 and 13 years.
Note also that the rear foot valgus medio is often found in more than 8 out of 10 cases.
It takes before this typical case, ask for an x-ray to confirm the normality of clich├ę and therefore, rule out other conditions such as bone tumor.
The treatment is very simple, but not always appreciated by the young man, as the essential element is strict rest to allow proper healing.
Standing time is different depending on the patient and is to be linked with the respect of pain.
If it hurts, I stop
 
Wearing a foot orthoses is imperative
This consists in a total discharge of the back foot, and places it on the heel with a damping area.
It will also correct the valgus the back foot medial to relieve plantar chain and pulley phenomenon, the posterior chain that can increase pain.
Wearing the orthotic must be done not only for sport, but also in school life and leisure.
The anti-inflammatory drugs and analgesics, may be considered when painful phases.
In most cases, the evolution of this disease is still favorable uncomplicated
However, failure to follow strict guidelines of respect for the pain can aggravate lesions secondary core and poor growth of the heel.
The total disappearance of the pain is in normality between 8 and 15 months.
Thomas will certainly resume his sport, from the establishment of the orthosis after a few days of adaptation.

Olivier HOMAGE. - 28 novembre 2011.

Conflicts of interest: the author or authors have no conflicts of interest concerning the data published in this article.

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