Young Athletes and Heel Pain

Young Athletes and Heel Pain

by | Apr 7, 2026 | Sports Medicine

Skeletally immature athletes, those that are still growing, have unique conditions that occur in the growth centers of the bones. Heel pain in adults is caused by different issues because their growth centers are closed. Sports medicine physician Jacob C. Jones, M.D., RMSK, says, “This is one of the most common conditions we see in the developing athlete. Though it is a condition that does not have lasting problems or require aggressive treatment, it can really disrupt an athlete’s training and competition. Following guidance for rest, cross-training, improving ankle mobility and delaying specialization can help to keep the heels game-ready.”

What are growth centers? 
The medical term for a growth center is a physis. The physis is an area of the bone that has soft tissue called cartilage that is later replaced by new bone cells. Some are areas where bone growth makes bones longer. Others, called apophyses, give the bones a unique shape. These growth centers are found in the elbow, pelvis, heel and other areas. The apophyses are attachment sites for tendons.

What growth center is in the heel?
The calcaneal apophysis is in the calcaneus (heel bone). The apophysis is the attachment site for the very strong tendon from the calf muscle, called the Achilles tendon.

What causes heel pain in the calcaneal apophysis?
Children become more committed to sports around 8-12 years old. With running, or repetitive jumping, the Achilles tendon pulls on the cartilage in the heel. This, accompanied by the impact on the ground with running and jumping, can lead to irritation in this area. Because this has a gradual onset, this is referred to as an overuse injury and is often referred to as Sever’s disease.

What is Sever’s Disease?
Sever’s disease, or calcaneal apophysitis, is a type of overuse injury and the most common cause of heel pain in active children ages 8-12. It is caused by repetitive movements, like running and jumping and may occur in only one or both sides. The pain is usually not related to a specific injury and comes on gradually.

What is the treatment for Sever’s disease?
Changing shoes or adding heel cups may be recommended to help with comfort during recovery. Simple ankle stretching exercises may also be helpful. Other treatments are available and should be considered on an individual basis, but rest is the most common prescription for this condition. Returning to a sport and other physical activity may gradually prevent recurrence. Pain may last months to years and may come back or worsen with increased sport or activity.

How long does Sever’s disease last?
Sever’s disease will resolve with completion of growth in this area. Because the growth plate is soft until it is closed, this problem can happen again in this age group. Pain in this area typically resolves by the mid-teenage years.

What factors may increase risk of initial or recurrent Sever’s Disease?

  • Playing sports on a hard surface or barefoot.
  • Footwear with poor cushioning, such as soccer cleats.
  • Year-round sports participation.
  • Sudden increase in training intensity.
  • Increase in duration or frequency of activity, such as tournaments and camps.
  • Tight Achilles tendon or calf muscle.

Learn more about Sever’s disease in this popular short lecture featuring sports medicine physician Jane S. Chung, M.D.

Limb Loss and Limb Differences: Terms You Need to Know

Limb Loss and Limb Differences: Terms You Need to Know

by | Apr 6, 2026 | Prosthetics & Orthotics

There are many different words that are used to describe limb loss and limb differences. These medical terms allow patients and their families to effectively communicate with their health care provider. This glossary of words and phrases will help you learn some of the terms used to describe limb differences and limb loss. 

Acquired amputation: The surgical removal of a limb(s) due to complications associated with disease or trauma.

Alignment: The position of the prosthetic socket in relation to the foot and knee.

Amputation: The surgical removal of all or part of a limb due to disease or injury.

Atrophy: A wasting away of a body part, or the decrease in size of a normally developed extremity or organ, due to a decrease in function and/or use.  After amputation, for example, some of the muscles in the remaining (residual) limb often atrophy over time since they are not being used as actively as before. 

Bilateral: Occurring on both sides, as in loss of both arms or both legs. Check or test socket: A temporary socket, often transparent, made over the plaster model to aid in obtaining proper fit and function of the prosthesis. Congenital limb deficiency: An absent, shortened or abnormal limb present at birth.

Custom fit: Fitting an individual with a device that is made from a scan or cast of the individual’s unique anatomy and fabricated according to the needs of that individual.

Extremity: A limb of the body, as in upper or lower extremity. Gait: Referring to the manner or style of walking. Gait training: Part of ambulatory rehabilitation, or learning how to walk, with your prosthesis or prostheses. Lower extremity (LE): Relating to the leg.

Nylon sheath: A shear nylon interface worn close to the skin on the residual limb to reduce friction and to help wick away perspiration from the surface of the skin.

Orthosis: A external device that is used to protect, support or improve function of parts of the body that move, i.e., braces, splints, slings, etc. It can include anything from an arch support to a spinal orthosis. Orthoses is plural.  

Orthotics: The profession of providing devices to support and straighten the body (orthoses).

Orthotist: A skilled professional who designs, fabricates, fits and maintains orthotic devices that are prescribed by a physician, generally as a collaboration regarding the biomechanical goals of the orthosis and the patient’s needs.

Proximal Femoral Focal Deficiency (PFFD): Proximal Femoral Focal Deficiency is a complex congenital difference in which the femur (thigh bone) is short or even mostly absent, making that leg significantly shorter than normal. PFFD includes a wide range of severity and multiple treatment options based on how big the length difference is, the child’s age and development and whether other parts of the limb or other extremities are involved.

Prosthesis/prosthetic device: An artificial limb, usually an arm or a leg, that provides a replacement for the amputated or missing limb. Prostheses is plural. Generally, the word prosthetic should be used as an adjective. If referring to an individual’s replacement artificial limb, it should be called a prosthesis not just a prosthetic.

Prosthetics: The profession of providing those with limb loss or with a limb difference (congenital anomaly) a functional and/or cosmetic restoration of missing or underdeveloped human parts.

Prosthetist: A person involved in the science and art of prosthetics; one who designs and fits artificial limbs.

Pylon: A structural part, usually a metal alloy or composite tube, that provides a relatively light weight support structure between other components of the prosthesis such as between the socket or knee unit and the foot.

Residual limb: The portion of the arm or leg remaining after an amputation, sometimes referred to as a stump or residuum. Revision: Surgical modification of the residual limb. Socket: Part of the prosthesis that fits around the residual limb.

Symes: a type of surgery for amputation through the ankle joint, generally retaining the heel pad so that the residual limb can tolerate more loading through that area.

Upper extremity (UE): Relating to the arm.

Van Nes (Rotationplasty): Rotationplasty is a surgical reconstruction occasionally indicated for bone tumors near the knee or for PFFD.  There are many variations of this surgery, but in general the limb is shortened, and the anatomical ankle and foot are moved up to about knee level and rotated around so the heel faces forward.  Once healed the person with a rotationplasty can eventually be fitted with a “below knee” prosthetic leg where the foot rests inside a custom socket and the rotated ankle is protected with metal joints and a thigh cuff.   The ankle then controls the prosthesis much like a knee but with slightly less overall range of motion.  

Cerebral Palsy Clinic: Your Child’s Care and What To Expect

Cerebral Palsy Clinic: Your Child’s Care and What To Expect

by | Oct 3, 2025 | Neurology

At Scottish Rite for Children, our experts provide care to the whole child – body, mind and spirit. The Neurology and Rehabilitation Medicine department sees children with orthopedic issues who also have related neurological disorders and neuromuscular diseases. One of the most common conditions seen by this team is cerebral palsy (CP).

Like all conditions, the severity of cerebral palsy can vary depending on the child and requires a multidisciplinary team to determine the best treatment options. With several factors that play into this diagnosis, we understand that as a parent or caregiver it can be challenging to navigate through the care plan for a child with cerebral palsy. Below is what you need to know about our specialized cerebral palsy clinic at Scottish Rite.

Who is part of the CP team?

  • Orthopedics: A pediatric orthopedic surgeon focuses on evaluating and monitoring for operative interventions to address function and pain
  • Pediatric Rehabilitation Medicine (PRM): PRM focuses on evaluating and monitoring the child for nonoperative interventions, including bracing, casting, tone medications, botulinum injections, equipment and therapies with the goal of optimizing function and reducing pain.
  • Neurology: This team treats the active neurological conditions such as seizures.
  • Advanced practice providers (APPs): The APPs work with both the neurologists and pediatric rehabilitation specialists to provide holistic care.
  • Nursing: This team coordinates and organizes each of the multidisciplinary teams and ensures that education is tailored to the needs of each patient.
  • Orthotics: A team of orthotists work with the teams to evaluate, fit and fabricate braces used to help your child’s mobility.
  • Physical therapy (PT): PT works with the child to improve functional mobility, with or without their needed equipment.
  • Occupational therapy (OT): OT focuses on activities of daily living, upper extremity function and the use of equipment needed to help your child function.
  • Therapeutic recreation (TR): TR works with the patient to promote activities and participation through peer interactions and relationships, such as adaptive sports, games and more.
  • Psychology: Our team of pediatric psychologists manage the psychological well-being of the child and helps them with strategies to overcome barriers to the treatment plan.
  • Developmental and Behavioral Pediatrics: This team optimizes nutrition, feeding and medical comorbidities and manages behavioral differences.

    What can a patient family expect when come to the CP clinic?

    First, the child will see a motor control nurse who will go over medications and safety questions. One of the neurology/rehabilitation medicine APPs will continue the visit. A video recording will be conducted of the child for their gait to be analyzed, so the team can compare any changes that occur throughout time. Then, the pediatric rehabilitation medicine specialist and the APPs will complete the visit and explain the plan to the patient family.

    Depending on the clinic and specific needs, the patient may also be seen by a pediatric orthopedic surgeon, orthotist, physical and/or occupational therapist, pediatric psychologist or a recreational therapist. When appropriate, referrals are also made to the other CP experts.

    How often are clinic appointments?

    • Children younger than 5 are typically seen every three to four months. Since this is a period of rapid growth and development, our team of experts want to make sure that they are monitoring the patient’s growth closely and intervening in any way needed to promote healthy and happy development.
    • Children between ages 6 to 12 are seen about every six months but may require visits more often if they are in the middle of a growth spurt.
    • After a child has completed their growth spurt, the team typically sees them between every six months to a year.

    Pediatric rehabilitation medicine physician Fabiola I. Reyes, M.D., works closely with this patient population. “I am honored to have the opportunity to provide care to these kids,” Reyes says. “In the CP clinic, we pride ourselves in making sure that both the child and parent/guardian understand and feel comfortable with every step of the treatment plan. Although your child may have several specialists caring for them, which can be overwhelming, our team is here to walk you through the process – making sure the patient remains our priority.”

    Learn more about the Neurology and Rehabilitation Medicine department.

    Lyda Hill Philanthropies Awards Scottish Rite for Children $1 Million to Study ACL Injury Prevention in Young Female Athletes

    Lyda Hill Philanthropies Awards Scottish Rite for Children $1 Million to Study ACL Injury Prevention in Young Female Athletes

    by | Sep 2, 2025 | Press Coverage, Sports Medicine

    Groundbreaking studies will address the ACL epidemic in active adolescent females by using movement science

    Movement science researchers at Scottish Rite for Children have received a $1 million grant from Lyda Hill Philanthropies to fund, in part, two projects addressing the concerning rise of ACL injuries in young female athletes. According to studies published in The American Journal of Sports Medicine, adolescent female athletes are at the highest risk of suffering an anterior cruciate ligament (ACL) injury: 29 times more likely than adult women and eight times more likely than their adolescent male counterparts.

    The grant supports Scottish Rite’s initiative to find new ways to combat this ACL injury epidemic, and the studies it funds will leverage technology and clinical collaboration to identify effective prevention tactics. The team will look at how to reduce ACL injury risk in adolescent female athletes by tracking and syncing their menstrual cycles to a training program, and using the Movement Science Lab to simulate and test real-time decisions made in sports that may lead to or prevent injury. A portion of funds will also support overall injury prevention efforts.

    “Because of this generous grant from Lyda Hill Philanthropies, our expert team is able to conduct vital research that will improve the care of young athletes,” says Scottish Rite for Children President/CEO Robert L. Walker. “We are grateful for the foundation’s support in this significant initiative to reduce sport-related injuries in young female athletes.”

    Despite decades of research, significant disparities remain regarding ACL injury risk in female athletes. This problem has recently received international attention, and several institutions have begun to investigate the link between ACL injuries and the menstrual cycle in adult female athletes. However, few studies include adolescent female athletes, leaving a gap in the understanding of how hormone fluctuations affect how the body moves, performs and experiences the pressures of sport.

    Under the leadership of Movement Science Division Director Sophia Ulman, Ph.D., the first study uses menstrual cycle tracking alongside neuromuscular training to better understand and adapt to the body’s physiological changes throughout the cycle. Early findings show that during the early follicular phase, right after menstruation begins, teen girls can experience up to a 42% increase in knee joint laxity, or looseness, which may raise their risk of ACL injuries by more than four times.

    “Our last two years of preliminary work has highlighted how much research is still needed in this area,” Dr. Ulman says. “ With this study, instead of continuing to research why female athletes experience eight times more ACL injuries than males, we are asking, ‘How do we address this problem?’”

    Participants in this study will track their menstrual cycle, allowing researchers to detect changes throughout different cycle phases. The neuromuscular training will adjust based on the cycle, using tailored strengthening exercises during the follicular phase and stability and balance exercises during the luteal phase, which is the second half of the cycle following ovulation. This approach targets phase-specific biomechanical risk factors unique to female athletes.

    “Mirroring the rise in youth sports, especially at the competitive level, ACL injuries in the U.S. have doubled in the past two decades,” Dr. Ulman says. “The last 20 years of research into ACL injuries have clearly identified different outcomes based on the sex of the athlete. With this study, we aim to find a way to combat the higher injury risks seen in girls.”

    The research team also includes pediatric sports medicine surgeon and Medical Director of Clinical Research Henry B. Ellis, M.D., along with biomechanists, bioengineers and a physical therapist on the Movement Science team. In addition to their work at Scottish Rite, Ulman and Ellis hold faculty positions at UT Southwestern Medical Center’s Department of Orthopaedic Surgery.

    “Young female athletes are at particularly high risk for serious injuries when playing competitive pivoting sports such as soccer and basketball,” Dr. Ellis says. “Our goal, through comprehensive multidisciplinary research, is to learn as much as we can about these injuries in hopes to provide families, coaches, athletic trainers and anyone involved in youth sports tools to prevent injuries in female athletes.”

    The menstrual cycle study will recruit female high school athletes ages 14 to 19 who play basketball and/or soccer to participate in an eight-week preseason training program that will be led by their high school coaches and supported by Scottish Rite’s Movement Science staff. Taking place at their schools, which span the socioeconomic spectrum, girls will be tested both pre- and post-training to determine if the program reduces injury risk for the sports season.In the second study, researchers will use competition-like scenarios to identify modifiable biomechanical risk factors.

    Young female athletes will be actively tested using alternating lights and actions during game-time scenarios, simulating the way the brain makes real-time decisions in competitive sport. Dual task exercises, such as memorizing color patterns while landing from a jump or moving in the direction of a light when it flashes, causes the athlete to make split-second decisions, like they would when deciding to pass the ball to a teammate during a soccer game. Scottish Rite’s team is studying how their body moves differently during these moments and how the athlete’s risk for injury may increase when their attention is divided. The data collected will help develop new rehabilitation protocols and return to play criteria, with the overarching goal of reducing the high rates of ACL reinjury.

    To learn more about Scottish Rite’s Center for Excellence in Sports Medicine, please visit https://tsrclegacyprd.wpenginepowered.com/care/sports-medicine/.

    5 Common Types of Scoliosis: Which Form Does Your Child Have?

    5 Common Types of Scoliosis: Which Form Does Your Child Have?

    by | Jun 4, 2025 | Scoliosis & Spine

    Scoliosis is a common orthopedic condition that affects between 2% to 3% of the population. This abnormal sideways curvature of the spine can range from mild to severe, with varying health impacts. Scoliosis must be monitored until children stop growing, and moderate to severe curves will need corrective treatment. However, different types of scoliosis have different prognoses and may require different types of treatment.

    What Is Scoliosis?

    Prior to learning about the different forms of scoliosis, it helps to first understand what this condition is and how any form of the disease can affect a child.

    Scoliosis happens when a child’s spine curves sideways. Normally, the spine is straight or has a slight S-curve when you look at it from the side — the top of a child’s back may curve out a little bit, and their lower back may curve in slightly. In children with scoliosis, the spine curves or twists in an S- or C-shape.

    Mild cases may only limit a child’s flexibility, but severe cases can cause deformities and serious health problems, such as:

    • Arthritis
    • Back pain
    • Breathing problems or other lung issues
    • Heart problems
    • Paralysis
    • Problems walking, standing or doing other physical activities

    Whether mild or severe, the form of scoliosis your child has can also play a role in its long-term impacts. Below are five common types of scoliosis.

    Idiopathic Scoliosis

    Idiopathic scoliosis, also called adolescent idiopathic scoliosis, is the most common type of scoliosis. It affects around 80% of children with scoliosis. It typically shows up at age 10 or later and has no known cause, although there is a genetic connection. About 30% of children with idiopathic scoliosis have a family history of scoliosis. Despite what many parents or kids may think, carrying a heavy backpack or slouching will not cause scoliosis.

    Treatment for this type of scoliosis depends on the severity of your child’s spinal curve, defined as:

    • Mild, less than 20 degrees
    • Moderate, between 25 degrees and 40 degrees
    • Severe, greater than 50 degrees

    Regardless of severity, many children with scoliosis benefit from physical therapy (PT). PT helps reduce pain and improve breathing, while also preventing a curve from getting worse.

    Children with mild curves may simply need monitoring every six to 12 months to ensure a curve is not getting worse. Moderate curves may require a child to wear an orthotic back brace daily for months or even years.

    Braces are usually successful in stopping the curve from progressing to a point of needing surgery. Severe curves or moderate curves that do not get better with bracing may require spinal surgery. Spinal fusion is the most common type of surgery for severe adolescent idiopathic scoliosis, but some patients may benefit from a newer technique, vertebral body tethering (VBT).

    Congenital Scoliosis

    Congenital scoliosis is a form of the condition that exists when a child is born. A rare birth defect, congenital scoliosis occurs in only 1 in 10,000 children. There are several different types of congenital scoliosis, each affecting how the spine curves abnormally in different ways. All can cause serious problems in children’s growth.

    Many children with congenital scoliosis are not diagnosed until the problem becomes noticeable later in childhood or during the teenage years. Unlike idiopathic scoliosis, congenital scoliosis usually cannot be helped by bracing. Children with mild curves will still likely only need monitoring, but those with moderate to severe curves may need surgery.

    Neuromuscular Scoliosis

    Neuromuscular scoliosis is caused by medical conditions that impact the muscular or neurological systems. These conditions can affect a child’s muscle balance or how the body controls the muscles that support the spine.

    Common neuromuscular conditions that lead to scoliosis include:

    • Cerebral palsy
    • Friedreich ataxia
    • Muscular dystrophy, especially Duchenne
    • Myelodysplasia
    • Spina bifida
    • Spinal muscle atrophy
    • Spinal trauma, especially that causing paralysis

    These conditions may require children with scoliosis to be in wheelchairs. For those children, wheelchair seats can be modified to improve balance.

    Bracing may also help many patients with neuromuscular scoliosis, but it will not stop the progression of curves. Surgery may be an option, depending on the underlying medical condition and other factors.

    Early-Onset Scoliosis

    Early-onset scoliosis develops before age 10. In most cases, early-onset scoliosis is idiopathic. Treatment is crucial for preventing breathing problems or deformities later in life.

    Infants and children younger than age 2 who have early-onset scoliosis may need to wear a cast for two to three months at a time. In children this young, casting is often easier than bracing.

    If a very young child’s scoliosis is severe, they may need a special type of surgery that involves attaching a magnetic rod to the spine. The rod can be lengthened as the child gets older, at which point they usually have spinal fusion surgery.

    Syndromic Scoliosis

    This type of scoliosis is very rare and develops as part of another condition, such as:

    • A connective tissue disorder, such as Marfan or Ehlers-Danlos syndrome
    • Beale’s syndrome
    • Down syndrome
    • Prader-Willi syndrome
    • Rett syndrome

    Treatment options for syndromic scoliosis depend on the severity and the other health conditions involved.

    Could Your Child Have Scoliosis?

    Children are usually screened for scoliosis during their annual wellness exams, and they may be screened at other times, such as during school health screenings.

    However, children grow quickly, so it’s important for parents to know the symptoms of scoliosis. Be on the lookout for signs such as:

    • Back pain
    • One shoulder blade that sticks out more than the other
    • One shoulder, hip bone or rib cage that seems higher than the other
    • Rounded shoulders
    • The sense that your child’s head is no longer directly centered above the pelvis
    • A sunken chest

    Call your child’s pediatrician if your child experiences any of these symptoms or if you notice an unusual spinal curve when your child bends forward to touch their toes. Getting treatment early, no matter which type of scoliosis your child has, often leads to more successful outcomes.

    If your child has been diagnosed with scoliosis, the Scottish Rite Center for Excellence in Spine is here to help. Schedule an appointment to discuss scoliosis care.