Childhood and Adolescent Pathology Series Part 3 – Knee and Heel Pain

Today’s blog will look at a couple of common knee and heel pathologies to round out our children and adolescent series. We will focus on Osgood-Schlatters Disease (OSD) which affects the knee, and Severs Disease which affects the heel. As with SUFE’s (see part 2 of this blog series), these two pathologies involve the growth plates. Let’s take a further look into these two issues and how we treat them in the clinic.

Osgood-Schlatters Disease

Osgood-Schlatters Disease is an irritated and inflamed growth plate at the front of the knee. It presents as pain just below the knee joint itself, on the bony protrusion at the top of your tibia called the tibial tubercle. This area is the site for your patella tendon to attach your quadriceps muscles to the tibia (see picture).

The tibial tubercle contains a growth plate which can become painful as a result of constant or repetitive pulling on the area. Constant pulling can occur as a result of progressively tightening quadriceps muscles. It makes sense then, that development of OSD usually coincides with the biggest growth spurt throughout puberty. During the growth spurt the femur can elongate quicker than the muscle and tendons can adapt which results in tight muscles and a constant traction force being placed on the tibial tubercle and hence the growth plate.

Repetitive pulling on the area generally occurs due to participation in sports or activities that require running and jumping. These activities require repetitive activation of the quadriceps which pulls on the patella tendon and in turn tractions the tibial tubercle and growth plate. Not surprisingly given these factors, OSD is most common in boys in between the ages 11-15 years, and girls between the ages 8-13 years.

Diagnosis and treatment of OSD is generally pretty straight forward, with some activity modification and pain relieving interventions such as taping and icing, anti-inflamms as well a mix of stretching and strengthening exercises. Symptoms can usually be held in check until the young person reaches bone maturity (growth plates turn into hard bone) at which point it no will no longer be an issue.
Sever’s Disease

Sever’s Disease is very similar to Osgood-Schlatters but it affects the heel. As you can see from the image below, the heel also contains a growth plate at the posterior calcaneus. As was the case with the tibial tubercle in OSD, there is a tendon that attaches to the piece of bone on the other side of the growth plate. The tendon in question is the Achilles tendon, which is the joint tendon for the gastrocnemius and soleus muscles (calf). Like OSD, repetitive pulling (jumping/sport) or constant tension (tight calf muscles) can be the cause of the growth plate irritation.

Symptoms for Sever’s mirror those of OSD, with tenderness around the growth plate, swelling in the area and aggravation by running or jumping activities. Treatment also requires some activity modification, pain relieving techniques, anti-inflammatories, as well as strengthening and stretching exercises. Most cases will respond well with treatment although some young people can have recurrent episodes. Once again, as soon as the adolescent reaches skeletal maturity, Sever’s Disease is no longer an issue due to the changing of the growth plate into mature, hardened bone.

That wraps up our children and adolescent pathology series. In the first blog we looked at some bone physiology, growth plates and fractures. In the second we took a dive into hip pain and in our last blog here we wrapped up with some growth plate pathologies in the knee and heel.