Addressing Severs Disease

Overview


Sever's Disease, also known as calcaneal apophysitis, is a disease of the growth plate of the heel bone (calcaneus) and is characterized by pain in the heel of a child's foot, typically brought on by some form of injury or minor trauma from sports participation. This condition is most common in children ages 9 to 14 and is frequently seen in active soccer, football, or baseball players. Sport shoes with cleats are also known to aggravate the condition. The disease can mimic Achilles tendonitis, an inflammation of the tendon attached to the back of the heel. A tight Achilles tendon contributes to Sever's Disease by pulling excessively on the growth plate of the heel bone. Feet that flatten out to excess (hyperpronate) are also prone to this problem, as this can involve extra torque on the calcaneus by the Achilles tendon.


Causes


There are several causes of heel pain in the young athletic population with the most common being calcaneal apophysitis (also referred to as Sever?s disease). Sever first reported calcaneal apophysitis in 1912 as an inflammation of the apophysis, causing discomfort to the heel, mild swelling and difficulty walking in growing children. The condition usually manifests between the ages of 8 and 14 with a higher incidence in boys than girls. In reality, however, calcaneal apophysitis is being diagnosed more frequently in girls due to their increase in participating in sports such as soccer, basketball and softball.


Symptoms


The typical patient is a child between 10 and 13 years of age, complaining of pain in one or both heels with running and walking. The pain is localized to the point of the heel where the tendo-Achilles inserts into the calcaneus, and is tender to deep pressure at that site. Walking on his toes relieves the pain.


Diagnosis


Radiography. Most of the time radiographs are not helpful because the calcaneal apophysis is frequently fragmented and dense in normal children. But they can be used to exclude other traumas. Ultrasonography. could show the fragmentation of secondary nucleus of ossification of the calcaneus in severs?s disease. This is a safe diagnostic tool since there is no radiation. This diagnostic tool can also be used to exclude Achilles tendinitis and/or retrocalcaneal bursitis.


Non Surgical Treatment


If your child have Sever's disease, the following is suggested, cut back on sporting activities, don't stop, just reduce the amount until symptoms improve (if the condition has been present for a while, a total break from sport may be needed later) avoid going barefoot, a soft cushioning heel raise is really important (this reduces the pull from the calf muscles on the growth plate and increases the shock absorption, so the growth plate is not knocked around as much). Stretch the calf muscles, provided the stretch does not cause pain in the area of the growth plate). The use of an ice pack after activity for 20mins is often useful for calcaneal apophysitis - this should be repeated 2 to 3 times a day.


Recovery


If the child has a pronated foot, a flat or high arch, or another condition that increases the risk of Sever's disease, the doctor might recommend special shoe inserts, called orthotic devices, such as heel pads that cushion the heel as it strikes the ground, heel lifts that reduce strain on the Achilles tendon by raising the heel, arch supports that hold the heel in an ideal position, If a child is overweight or obese, the doctor will probably also recommend weight loss to decrease pressure on the heel. The risk of recurrence goes away on its own when foot growth is complete and the growth plate has fused to the rest of the heel bone, usually around age 15.

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Crystle Altwies

Author:Crystle Altwies
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