Walter Larman

The Earth's Greatest Foot Website

Addressing Severs Disease

Overview

Sever condition is an inflammation of the growth plate of the bone at the back of the heel (apophysitis of the calcaneus). The inflammation of Sever condition is at the point where the Achilles tendon attaches to the back of the heel bone. What causes Sever condition? Sever condition is caused by sprain injury where the Achilles tendon attaches to the calcaneus bone at the back of the heel. Sever condition occurs in adolescent or older children, particularly active boys. It can be very painful. It is one of those conditions commonly referred to as "growing pains." Patients are evaluated for signs of conditions that can mimic Sever condition, such as ankylosing spondylitis and other forms of arthritis. Usually Sever condition is self-limited; that is, it disappears as the child ages.

Causes

Sever?s disease is common, and typically occurs during a child?s growth spurt, which can occur between the ages of 10 and 15 in boys and between the ages of 8 and 13 in girls. Feet tend to grow more quickly than other parts of the body, and in most kids the heel has finished growing by the age of 15. Being active in sports or participating in an activity that requires standing for long periods can increase the risk of developing Sever?s disease. In some cases, Sever?s disease first becomes apparent after a child begins a new sport, or when a new sports season starts. Sports that are commonly associated with Sever?s disease include track, basketball, soccer, and gymnastics. Children who are overweight or obese are also at a greater risk of developing this condition. Certain foot problems can also increase the risk, including. Over pronating. Kids who over pronate (roll the foot inward) when walking may develop Sever?s disease. Flat foot or high arch. An arch that is too high or too low can put more stress on the foot and the heel, and increase the risk of Sever?s disease. Short leg. Children who have one leg that is shorter than the other may experience Sever?s disease in the foot of the shorter leg because that foot is under more stress when walking.

Symptoms

Chief complaint is heel pain which increases pain during running and jumping activities. Pain is localized to the very posterior aspect of the heel. Pain is elicited only with weightbearing. Mild involvement is present if pain is brought on only with running during sports. The symptoms can be severe, with pain (and possibly limp) with activities of daily living (ie walking).

Diagnosis

A physical exam of the heel will show tenderness over the back of the heel but not in the Achilles tendon or plantar fascia. There may be tightness in the calf muscle, which contributes to tension on the heel. The tendons in the heel get stretched more in patients with flat feet. There is greater impact force on the heels of athletes with a high-arched, rigid foot. The doctor may order an x-ray because x-rays can confirm how mature the growth center is and if there are other sources of heel pain, such as a stress fracture or bone cyst. However, x-rays are not necessary to diagnose Sever?s disease, and it is not possible to make the diagnosis based on the x-ray alone.

Non Surgical Treatment

In general, the goals for treatment include reducing the localized areas of inflammation. We recommend that patients utilize Ibuprofen every six to eight hours as needed. Stretching exercises on a daily basis, as well as prior to activity is thought to be helpful as well. Following work-outs and increased activities, it may be helpful to apply ice over affected areas. Heel cups are also available to provide cushion in shoes. In addition, for more severe symptoms, it may be helpful to refrain from sports and/or immobilize the area for a few weeks to help reduce the inflammation.

Prevention

The best way to prevent Sever?s disease is for your child to stay flexible and stretch the hamstring, calf muscles, and the Achilles tendon before and after activity each day. It?s important to hold the stretches for 20 seconds and stretch both legs, even if there is only pain in one. If he or she only has smaller symptoms, like swelling and some tenderness, consider your child lucky. They may only have to sit out for one to two weeks during the season. The best treatment is to immediately stop the activity that caused the pain. Elevate and ice the heel for 20 minutes at a time to relieve discomfort and swelling.
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