Juvenile Osteochondrosis Page 2

4. OSGOOD-SCHLATTER DISEASE (KNEE PAIN) 
Courtesy of Dr. Tony Moya, MD, PhD, FAAOS

Description

Osgood-Schlatter disease is an overuse injury that occurs in the knee area of growing adolescents. It is caused by inflammation of the tendon below the kneecap (patellar tendon) where it attaches to the shinbone (tibia). Young adolescents who participate in certain sports, including soccer, gymnastics, basketball, and distance running, are most at risk for this disease.

Symptoms

  • Knee pain
  • Swelling
  • Tenderness below the kneecap

Treatment:

Once a diagnosis has been made, treatment is aimed at reducing the pain and swelling. This may include the use of nonsteroidal anti-inflammatory drugs and wrapping the knee until the child can enjoy activity without discomfort or significant pain afterwards.

Symptoms that worsen with activity may require rest for several months, followed by a conditioning program. In some patients, Osgood-Schlatter symptoms may last for 2 to 3 years. However, most symptoms will completely disappear with completion of the adolescent growth spurt, around age 14 for girls and age 16 for boys.

SEVER'S

Sever's is painful inflammation to the growth plate (calcaneal apophysis) in the back of the heel.

CAUSE:

  • Over activity in children between the ages of 8 and 14.
  • Tight muscles in the lower extremity, especially the calf muscles.
  • Flatfeet.
  • Growth spurts.
  • Poor shoe gear or walking barefoot on hard surfaces.

SYMPTOMS:

  • Mild discomfort in the heel bone at the end of an activity.
  • Stiffness in the foot in the morning and pain with walking.
  • Pain alleviated by rest and a decrease in activity.
  • Stiffness and pain is usually present after a child is done with the activity, sits for a period of time and then tries to get up and walk.

SIGNS:

  • Tenderness to the back and bottom of the heel with touch or grasping the heel.
  • Walking on the ball of the foot to avoid touching the heel to the ground.
  • Discoloration and swelling are almost never seen in the heel.
  • Limping at the end of an activity that may persist as the condition worsens.

TREATMENT:

  • Modification of activity and avoiding going barefooted.
  • Taping the foot to decrease the pulling of the plantar fascia on the heel bone.
  • Proper shoe gear and heel lifts to decrease tension on the heel.
  • Night splinting to stretch the tight calf muscle and arch ligament.
  • Custom molded orthotics to support the foot and help restore proper alignment.
  • Physical therapy to improve flexibility and diminish inflammation of the growth plate.
  • Occasional immobilization  in a cast or brace to completely rest the heel and allow healing.