jill wrote:
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My 12 year old son was first told he had an open growth plate in his heel & then told he has plantar fasciitis. He has never had xray done. One foot does hurt more than the other. You can see a difference in the arches in each foot. He has been in physical therapy for the plantar fasciitis for a month now & the streching has helped(his calfs were very tight too). He does have some relief. I was recently told he is too young to have plantar fasciitis. He plays both basketball & football. Is there a definate determining factor in figuring out which he has?
Thank you
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Law of averages would have to lean strongly on the side of calcaneal apophysitis, He's the right sex, the right age, he's active in sports and I assume not greatly overweight if at all, and mitigating of the tension from the Achilles tendon would be advantageous in either condition.
It is often difficult to accurately discern the appearance of a normal and an inflamed apophysis on x-ray, as both normally appear fragmented, but, in my experience, in calcaneal apophysis, significant pain can be elicited by squeezing the medial and lateral sides of the area of the growth plate between the thumb and a finger, while plantar fasciitis would be most painful if pone were to press on the center of the bottom of the heel, but just slightly toward the midline of the body. Also, plantar fasciitis is most painful when beginning weight-bearing after a period of rest, and often tends to get less painful as one continues to walk on it. Pain of calcaneal appophysitis, on the other hand, generally increases with use of the foot.
The aggressiveness of treatment of calcaneal apophyisitis is generally dictated by the severity of symptoms and the success or failure of conservative treatment. I generally start out by have the parent and the child agree not to allow participation in weight-bearing sports until well after symptoms are resolved. I begin, in mild to moderate cases, with a heel pad of significant height and will perhaps go into an in-shoe orthotic device. Severe case may require casting. In any event, recurrences are not uncommon, as the child frequently will not leave well enough alone when the pain lessens. But this condition is self-limiting, and will resolve whether or not treated when the growth plate closes in a few years.
First thing to do, though, is to get him a firm diagnosis.
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