Sever?s disease is irritation of the growth plate in the heel. If rest is prescribed by your doctor, you should probably listen! But, there is usually an underlying cause of this irritation, and we
need to address what?s causing it if we don?t want it to come back the first time an athlete jumps, runs, or kicks a ball.
When a baby is born, most of the bones are still cartilage with only some starting to develop into bone. When the heel (calcaneus) starts to develop bone, there is generally one large area of
development that starts in the center of the cartilage heel. This area of bone spreads to 'fill up' the cartilage. Another area of bone development (ossification) occurs at the back of the heel bone.
These two areas of developing bone will have an area of cartilage between them, this is how the bone grows in size. At around age 16, when growth is nearly complete, these two bony areas fuse
together. Sever's disease or calcaneal apophysitis is usually considered to be due to damage or a disturbance in this area of growth.
Activity-related pain that occurs on the back of the heel, where the Achilles tendon attaches on to the heel bone. Tenderness, pain & swelling on the heel bone. Difficulty walking or walking with
a limp or on tiptoes.
Sever's disease is based on the symptoms reported. To confirm the diagnosis, the clinician will examine the heels and ask about the child's activity level and participation in sports. They may also
squeeze the back part of the heel from both sides at the same time to see if doing so causes pain and also ask the child to stand on tiptoes to see if that position causes pain. There may be
tightness in the calf muscle, which contributes to tension on the heel. Symptoms are usually worse during or after activity and get better with rest. X-rays generally are not that helpful in
diagnosing Sever's disease, but they may be ordered to rule out other problems, such as fractures. Sever's disease cannot be seen on an X-ray.
Non Surgical Treatment
Depending on the diagnosis and the severity of the pain, there a number of treatment options available. Rest, reduce activity, your child should reduce or stop any activity that causes pain, such as
sports and running. This can be a difficult option, as children are normally quite willful in pursuit of their favorite pastimes. Over the counter anti-inflammatory drugs, such as ibuprofen (found in
Nurofen), to help reduce pain and inflammation. Make certain your child does stretching exercises before play. This will often help reduce the stress on the fascia and relieve heel pain in your
child. Orthotic insoles. Orthotics made for children will help support the foot properly, and help prevent over-pronation or improper gait by supporting your child?s foot into a proper biomechanical
position. Do not hesitate to schedule an appointment with a podiatrist, should your child?s heel and foot pain persist.
To prevent recurrence, patients, parents, coaches, and trainers should be instructed regarding a good preexercise stretching program for the child. Early in the season, encouragement should be given
for a preseason conditioning and stretching program. Coaches and trainers should be educated about recognition of the clinical symptoms so they are able to initiate early protective measures and seek
medical referral when necessary.