Sever’s Disease

Sever’s Disease

Sever’s Disease (also known as calcaneal apophysitis) is a painful condition found in adolescent kids that results from inflammation of the growth plate of the heel. It usually occurs during a rapid growth spurt in early puberty when the heel bone grows quicker than the connecting muscles and tendons. This causes them to become overstretched and less flexible thereby increasing the pressure exerted on the heel bone and its growth plate. With prolonged load on the growth plate, swelling, inflammation, and pain result.

Causes of Sever’s Disease can be from the stress associated with normal physical activities involving running and jumping. When physical exertion is performed on hard surfaces, the condition can be accelerated. Incorrect shoes (unbalanced load on the heel, insufficient support or excess friction on the heel) and standing for long periods of time have also been known to result in Sever’s Disease.

Sever’s Disease can affect any child but there are known conditions which make one more susceptible to it. They include:

• Having a pronated foot will increase the load on the growth plate (due to increased tightness and twisting of Achilles tendon).
• Tightness and shortening of the Achilles will also be evident with those having a flat or high arch.
• Children diagnosed with having one leg shorter than the other. The shorter leg will have to compensate to touch the ground and this causes increased load on the Achilles tendon.
• Being overweight will also increase the load on the growth plate.

The obvious indication of Sever’s Disease is pain and tenderness in both or one of the heels, usually around the back of the heel. The pain can also extend round to the sides of the heel or to the bottom of the heel (at the junction between the heel and the arch). Other signs could be:

• swelling and redness(inflammation) in the heel
• difficulty in performing one’s normal walking gait
• stiffness and/or discomfort in the feet upon waking up in the mornings
• discomfort can also be extended to the sides of the heels when pressure is applied
• symptoms get worse during and after activity and will ease off with rest

The first priority of treatment is that of pain relief. As mentioned before, activity will make it worse, so the first form of treatment is usually REST to facilitate a decrease in swelling and thereby pain. All activities that result in pain should be avoided until all symptoms are gone (especially when performed barefoot or on hard surfaces).

Other recommendations include:

• Performing physical activities that are non-weight bearing i.e. swimming, cycling.
• A physiotherapist could prescribe foot and leg exercises to lengthen and strengthen the muscles and tendons around the foot and ankle.
• RICE principle is always relevant. Rest has already been mentioned, but ice, elevating the foot and wearing a compression bandage/garment will accelerate the reduction in swelling.
• Pain medication (over the counter) could be prescribed to help manage the pain and further facilitate the swelling process.

One of the most important things to remember is that with proper care and management, the child should be fully recovered within 2-to-8 weeks and it won’t cause future complications. The sooner the issue is addressed, the quicker the recovery and most children will be able to return to their normal activities once they are completely pain-free.

Also important to note is that although it shouldn’t return, there are things that can be addressed to prevent it reoccurring. This includes the following:

• If overweight, losing weight will decrease the stress and load on the heel.
• Good quality and well-fitting shoes will also decrease the stress exerted on the heel. If the issue is due to friction, sandal-type shoes could be worn.
• Children with poor foot mechanics could be recommended to wear orthotics to correct the loading patterns on the heel and foot

The risk of reoccurrence will be eliminated once the foot has completed its growth process and the growth plate has fused to the heel bone. This occurs around the age of 15 in most children.