Overview
Sever?s Disease is often misdiagnosed as a simple growing pains and affects boys far more often than girls, especially between the ages of 8 and 14. It is extremely common in children that play Soccer, Basketball, And Hockey. However it is not limited to these sports alone, nor is it simply a pre-season type condition related to fitness. Sever?s Disease sounds terrible, but there is no need to panic as it is not a contagious or incurable condition. In children, there is a growth plate in the heel bone, which at puberty becomes solid and forms part of the heel, however prior to puberty it can cause pain if the child?s foot rolls inwards or outwards too much, causing increased stress on this growth plate and inturn causes pain.
Causes
Sever's Disease is a repetitive strain injury caused by the following. High impact injury activities and sport like netball, football, soccer, hockey, basketball, running, jumping and tennis. Tight calf muscles. Poor mechanics, structure and function of the foot. Excessive pronation. Rapid growth spurt. The above causes tension, inflammation and pain where the Achilles tendon inserts onto the calcaneus (Back/bottom surface of the heel bone). It is important that this problem is treated and monitored until the growth plate ossifies in the heel. This could occur between the ages of 14 and 16 years of age. In extreme cases the growth plate can become separated from the calcaneus.
Symptoms
Pain in the lower calf and heel area which may be worse when applying pressure either side. Pain worse on activity especially those involving running or jumping. In severe cases this may cause the child to limp when walking. One or both heels affected.
Diagnosis
To diagnose the cause of the child?s heel pain and rule out other more serious conditions, the foot and ankle surgeon obtains a thorough medical history and asks questions about recent activities. The surgeon will also examine the child?s foot and leg. X-rays are often used to evaluate the condition. Other advanced imaging studies and laboratory tests may also be ordered.
Non Surgical Treatment
Massage the calves gently from the knee to the heel, being especially careful around the Achilles? tendon, as this will be extremely tight and tender. During this massage, flex and point the foot through normal pain-free ranges of motion to increase flexibility while massaging. Massage every other or every third day, making sure your young athlete is not still sore before massaging again. If you?re unsure how to massage, find someone in your area that uses Graston technique or Active Release Therapy for best results. Stretch your athlete?s calves. This is the most overlooked aspect of treatment for Sever?s Disease and this needs to be done every day after practice, and when first starting we recommend 2-3 times per day, allowing gravity to pull heel down, never forcing the stretch. Ice your heels, but don?t just put an ice pack there. Use a cold water soak to fully immerse the foot and calves up to the knee. We recommend using a rubbermaid can found here. Soak for 10-15 minutes. The water does not have to be frigid, just cold. Use cold water from the tap, insert the foot, then add some ice to help bring down the temperature. When your athlete is experiencing pain, ice every hour, on the hour, for as many times as possible in one day. Make sure the heel/calves are body temperature before beginning again. Support the arches. This is what has been shown in studies to reduce pain in young athletes with Sever?s Disease. If you miss out on this one, you miss out on relieving your athletes pain.
Surgical Treatment
The surgeon may select one or more of the following options to treat calcaneal apophysitis. Reduce activity. The child needs to reduce or stop any activity that causes pain. Support the heel. Temporary shoe inserts or custom orthotic devices may provide support for the heel. Medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, help reduce the pain and inflammation. Physical therapy. Stretching or physical therapy modalities are sometimes used to promote healing of the inflamed issue. Immobilization. In some severe cases of pediatric heel pain, a cast may be used to promote healing while keeping the foot and ankle totally immobile. Often heel pain in children returns after it has been treated because the heel bone is still growing. Recurrence of heel pain may be a sign of calcaneal apophysitis, or it may indicate a different problem. If your child has a repeat bout of heel pain, be sure to make an appointment with your foot and ankle surgeon.
Sever?s Disease is often misdiagnosed as a simple growing pains and affects boys far more often than girls, especially between the ages of 8 and 14. It is extremely common in children that play Soccer, Basketball, And Hockey. However it is not limited to these sports alone, nor is it simply a pre-season type condition related to fitness. Sever?s Disease sounds terrible, but there is no need to panic as it is not a contagious or incurable condition. In children, there is a growth plate in the heel bone, which at puberty becomes solid and forms part of the heel, however prior to puberty it can cause pain if the child?s foot rolls inwards or outwards too much, causing increased stress on this growth plate and inturn causes pain.
Causes
Sever's Disease is a repetitive strain injury caused by the following. High impact injury activities and sport like netball, football, soccer, hockey, basketball, running, jumping and tennis. Tight calf muscles. Poor mechanics, structure and function of the foot. Excessive pronation. Rapid growth spurt. The above causes tension, inflammation and pain where the Achilles tendon inserts onto the calcaneus (Back/bottom surface of the heel bone). It is important that this problem is treated and monitored until the growth plate ossifies in the heel. This could occur between the ages of 14 and 16 years of age. In extreme cases the growth plate can become separated from the calcaneus.
Symptoms
Pain in the lower calf and heel area which may be worse when applying pressure either side. Pain worse on activity especially those involving running or jumping. In severe cases this may cause the child to limp when walking. One or both heels affected.
Diagnosis
To diagnose the cause of the child?s heel pain and rule out other more serious conditions, the foot and ankle surgeon obtains a thorough medical history and asks questions about recent activities. The surgeon will also examine the child?s foot and leg. X-rays are often used to evaluate the condition. Other advanced imaging studies and laboratory tests may also be ordered.
Non Surgical Treatment
Massage the calves gently from the knee to the heel, being especially careful around the Achilles? tendon, as this will be extremely tight and tender. During this massage, flex and point the foot through normal pain-free ranges of motion to increase flexibility while massaging. Massage every other or every third day, making sure your young athlete is not still sore before massaging again. If you?re unsure how to massage, find someone in your area that uses Graston technique or Active Release Therapy for best results. Stretch your athlete?s calves. This is the most overlooked aspect of treatment for Sever?s Disease and this needs to be done every day after practice, and when first starting we recommend 2-3 times per day, allowing gravity to pull heel down, never forcing the stretch. Ice your heels, but don?t just put an ice pack there. Use a cold water soak to fully immerse the foot and calves up to the knee. We recommend using a rubbermaid can found here. Soak for 10-15 minutes. The water does not have to be frigid, just cold. Use cold water from the tap, insert the foot, then add some ice to help bring down the temperature. When your athlete is experiencing pain, ice every hour, on the hour, for as many times as possible in one day. Make sure the heel/calves are body temperature before beginning again. Support the arches. This is what has been shown in studies to reduce pain in young athletes with Sever?s Disease. If you miss out on this one, you miss out on relieving your athletes pain.
Surgical Treatment
The surgeon may select one or more of the following options to treat calcaneal apophysitis. Reduce activity. The child needs to reduce or stop any activity that causes pain. Support the heel. Temporary shoe inserts or custom orthotic devices may provide support for the heel. Medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, help reduce the pain and inflammation. Physical therapy. Stretching or physical therapy modalities are sometimes used to promote healing of the inflamed issue. Immobilization. In some severe cases of pediatric heel pain, a cast may be used to promote healing while keeping the foot and ankle totally immobile. Often heel pain in children returns after it has been treated because the heel bone is still growing. Recurrence of heel pain may be a sign of calcaneal apophysitis, or it may indicate a different problem. If your child has a repeat bout of heel pain, be sure to make an appointment with your foot and ankle surgeon.