Adolescents engaged in sports are often prone to growth-related conditions, including Sever’s  (calcaneal apophysitis) and Osgood-Schlatter Disease (tibial tuberosity apophysitis). These conditions arise due to repetitive stress on growth plates during periods of rapid skeletal growth. Growth plates are the areas of new bone growth in adolescents, usually near the ends of long bones, such as the thigh or shin bone. Early recognition and treatment are essential to prevent long-term issues.

What is Apophysitis? 

Apophysitis is an overuse injury that occurs when there is inflammation at an apophysis (the growth plate where tendons attach to bones) typically seen in children and adolescents during periods of rapid growth and/or excessive activity.

Why does it happen?

The early adolescent growth spurt causes bone growth to exceed that of the muscle-tendon unit. As a result, the muscle-tendon unit loses the ability to stretch sufficiently causing increased tension across the incompletely-ossified (closed) apophysis. This stress can irritate the growth plate causing inflammation and subsequently pain.

 

Sever’s 

Sever’s disease typically presents in children aged 8–14, especially those participating in running or jumping sports. It causes pain at the back of the heel where the Achilles tendon attaches to the calcaneus (heel bone). 

Symptoms include: 

•  Heel pain during or after activity.
• Tenderness and swelling at the heel. 
•  Limping or difficulty walking barefoot.

Treatment

• Rest and Activity Modification: Avoid high-impact activities until pain subsides. 
• Ice Therapy: Apply ice packs for 15–20 minutes after activity to reduce inflammation. 
• Stretching and Strengthening: Focus on calf (straight leg) and soleus (bent knee) stretches to relieve tension on the growth plate. 
• Supportive Footwear or Heel Pads: Shock-absorbing inserts can help distribute pressure.

Symptoms usually resolve with appropriate rest and rehabilitation, but recurrence is common during growth spurts.

 

Osgood-Schlatter Disease

Osgood-Schlatter disease affects children aged 10–15, particularly those involved in sports requiring jumping or squatting. It causes pain at the tibial tuberosity (just below the kneecap) where the patellar tendon attaches. 

Symptoms: 

• Pain and swelling below the kneecap where the patella tendon attaches to the tibia (shin bone), worsening with activity. 
• Tenderness over the tibial tuberosity. – A noticeable bony bump in severe cases. 

Treatment:

• Rest and Activity Modification: Limit activities that strain the knee, such as running or jumping.
• Ice Therapy: Apply ice for 15–20 minutes after activity to ease inflammation. 
• Stretching and Strengthening: Quadriceps and hamstring stretches reduce stress on the tibial tuberosity, while strengthening stabilises the joint. 
• Knee Straps: May provide psychological support during activities but evidence of their efficacy is limited

Symptoms often subside with skeletal maturity, though some patients may retain a bony prominence.

 

Final Thoughts

Both Sever’s and Osgood-Schlatter disease are self-limiting and improve with conservative management. Parents and coaches should encourage children to listen to their bodies, rest appropriately, and seek professional advice if symptoms persist.