Calcaneal apophysitis

　　1. Etiology

　　Due to the acute or chronic traction of the calcaneal tuberosity by the Achilles tendon during weight-bearing.

　　2. Pathogenesis

　　The calcaneal tuberosity is the second ossification center of the calcaneus, belonging to the traction epiphysis, with a strong attachment of the Achilles tendon. It appears between the ages of 7 to 10, consisting of one or several ossification centers, which later form a crescent ossification center and fuse with the calcaneus between the ages of 15 to 18. The direct cause of the disease is the acute or chronic traction of the calcaneal tuberosity by the Achilles tendon during weight-bearing, or excessive friction on the heel by the hard back of the shoe. The calcaneal tuberosity can have many anatomical variations, and the normal density can be greater than that of the calcaneus itself. Therefore, in recent years, some scholars believe that it is a variation of a normal epiphysis.

　　Juvenile calcaneal apophysitis often occurs during the rapid growth period of adolescents, and the vast majority of patients seek medical attention mainly because of the deformity of the calcaneus. Some patients may have joint pain, with 50% of patients complaining of pain, mainly located in the deformed area, which worsens after activity. Usually, it improves as growth ends, and only 25% of patients have more typical symptoms as they approach maturity.

　　The main symptoms are pain, swelling, and tenderness at the back of the heel, with the child walking on the toes or with mild limping. Running, jumping, walking for a long time, or pulling on the Achilles tendon attachment for a long time can exacerbate the pain. Due to this, the child cannot participate in sports activities, and examination shows tenderness and mild swelling on both sides below the back of the calcaneus.

　　Avoid long-term intense exercise. Long-term, excessive, and intense exercise or activity is one of the basic causes of osteoarthritis. It is necessary to engage in physical exercise appropriately. Appropriate exercise, especially joint exercise, can increase the pressure inside the joint cavity, which is beneficial for the penetration of synovial fluid into cartilage, alleviate the degenerative changes of joint cartilage, and excessive weight can accelerate the wear of joint cartilage. Therefore, it is important to maintain a healthy weight. In addition, whether it is labor or leisure and entertainment, one should think about changing postures frequently to avoid the pressure caused by fixed postures on the joints.

　　On X-ray films, it can be seen that there is soft tissue swelling at the attachment site of the Achilles tendon, the gap between the body of the calcaneus and the bone protuberance is widened, the shape of the bone protuberance is irregular, it becomes flat or cracked, it is smaller than the healthy side, the density is higher, sometimes呈 segmented or spotted dense shadows, the part of the calcaneus corresponding to the epiphysis becomes rough and uneven, the bone protuberance is usually 2-3 ossification centers, which do not fuse with each other. Some people point out that the normal calcaneal bone protuberance can have several ossification centers, and their shapes can be different, the density is high, and the edges can also be irregular, which is similar to the manifestation of this disease, so the diagnosis should be closely combined with clinical findings.

　　1. Foods that are good for calcaneal apophysitis

　　Reasonable diet and proper matching, do not eat monotonously. Eat in moderation, do not overeat or starve. Quit smoking and alcohol. Increase the intake of calcium, eat high-calcium foods such as milk, eggs, soy products, vegetables, and fruits, and supplement calcium as needed.

　　2. Foods to avoid for calcaneal apophysitis

　　Avoid eating any citrus fruits, especially oranges and tangerines, and pay attention to the diet for osteophytes. Also avoid sugar, alcohol, and coffee. These substances will hinder the healing process and disrupt the balance of minerals in the body.

　　1. Treatment

　　When the lesion is mild, the child can walk and stand less, and avoid strenuous exercise. To reduce and relax the tension and pressure of the Achilles tendon and the pull force of the calcaneus, raise the heel of the shoe by 1-2 cm or change to soft leather shoes, and the symptoms can disappear spontaneously. If there is severe local swelling and pain, accompanied by bursitis, local injection of triamcinolone acetonide (Triamcinolone Acetonide) can be used to relieve symptoms. For a few patients, the foot can be immobilized in a downward position for 4-6 weeks with a cast, and physical therapy and hot compresses can be used after the cast is removed.

　　2. Prognosis

　　The disease is self-healing and has a good prognosis.