Achillies tendonitis in 10y.o?

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I had a 10y.o. girl in this week, she is otherwise healthy, active (dances 1 x week, netball 1 x week) with pain of left acillies tendon (2-3cm proximal to insertion) for 1 months.

Gastro-soleal flexibility normal-hyperflexible. footwear varies from runners to flat 'ballet flat' type shoes.

Has beeen wearing runners to school as they make it feel slightly better.

The presentation of this patient seems like typical achillies tendonitis, though I find it odd that she is so young and have not seen it before in a child?

As initial treatment plan I have got her in a good pair of cross-trainers, have issued heel lifts, and calf stretching program.

Has anybody got any advice or opinions?

Thanks

 

Maybe get an ultrasound. I have never seen it occuring in someone so young, which is possibly why a more thorough investigation would be warranted.

 

I agree. Have you checked her other shoes to ensure that they are not irritating in some way? Just a thought given the positive change with other shoes.

 

Could be due to an acute injury? Perhaps she was kicked there playing in the school yard? Certainly the change to runners will assist in GRFs at heel strike and transfer to the achillies. Contrats packing I've found great for soft tillue injuries, get her doing that daily, and I'd probaby go ultrasound as Secret Squirrel suggested, but woudl wait to see if there was no improvement in two weeks.....
Hope that helps!

 

Melbpod

All things being equal (I assume here that your patient has no redness, swelling, warmth) I would treat like any other tendinitis. 2-3 cm proximal to the insertion is still at the posterior aspect of the os calcis. She is not too young for apophysitis.

I would treat with rest, ice, 1/4 inch bilateral heel lift, decreased activity, stretching if not painful to do them.
If it is not beginning to improve in 10 days or so I would do more diagnostics (x-ray is the obvious first thing you would need)

Good luck

Steve