Addressing Severs Disease

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Overview

Sever's disease, or calcaneal apophysitis, is a common cause of heel pain in patients whose bones are still growing; however, it is not really a disease. The pain is caused by stress at the point where the Achilles tendon meets tissue called the plantar fascia on the growth plate (apophysis) of the heel bone (calcaneus). Sever's affects boys more often than girls. Boys are most often affected at age 12, and girls at age 9, though Sever's is typically seen in children and adolescents between the ages of 7 and 15.

Causes

Your child is most at risk for this condition when he or she is in the early part of the growth spurt in early puberty. Sever's disease is most common in physically active girls 8 years to 10 years of age and in physically active boys 10 years to 12 years of age. Soccer players and gymnasts often get Sever's disease, but children who do any running or jumping activity may also be at an increased risk. Sever's disease rarely occurs in older teenagers because the back of the heel has typically finished growing by 15 years of age.

Symptoms

Sever?s is recognized by pain in the back and lower regions of the heel. It usually starts during or immediately following the child's growth spurt, and/or in very active individuals. The child will usually have pain during or following participation in sport, and will often be seen limping off the field or court. Symptoms of Sever's include painful heel, no swelling or warmth, night pain is absent, pain is worse with increased activity, pain which is usually relieved by rest. Children often hobble or limp from the sports field.

Diagnosis

Sever's disease is diagnosed based on a doctor?s physical examination of the lower leg, ankle, and foot. If the diagnosis is in question, the doctor may order X-rays or an MRI to determine if there are other injuries that may be causing the heel pain.

Non Surgical Treatment

Rest is best to allow healing .Only do as much exercise as able without causing pain. Many children can continue to play sports but if pain is severe then stopping the activity may be the only way to allow the pain to settle. The child might be able to do things that do not put pressure on the heel, such as swimming and cycling. Ice and cold therapy may be useful to reduce pain and swelling, particularly following activity or sport. The area should be iced until it feels cold not ?frozen?. Never apply ice directly onto the skin, as this may cause tissue damage. Medication. The following will help treat your child?s pain. Paracetamol (see bottle for instructions) Ibuprofen (see bottle for instructions). Exercises, perform foot and leg exercises to stretch and strengthen the leg muscles & tendons. Increase calf flexibility by doing calf stretches several times per day. Protect the heel, your shoes might need a heel lift or arch support. Select a shoe with good arch support and heel lift if possible. Take it one step at a time: gradually resume running and impact activities as symptoms allow.

Exercise

For children with Sever's disease, it is important to habitually perform exercises to stretch the hamstrings, calf muscles, and the tendons on the back of the leg. Stretching should be performed 2-3 times a day. Each stretch should be performed for 20 seconds, and both legs should be stretched, even if the pain is only in one heel. Heel cups or an inner shoe heel lifts are often recommended for patient suffering from Sever's disease. Wearing running shoes with built in heel cups can also decrease the symptoms because they can help soften the impact on the heel when walking, running, or standing.

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