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.
Severs disease is often associated with a rapid growth spurt. As the bones get longer, the muscles and tendons become tighter as they cannot keep up with the bone growth. The point at which the achilles tendon attaches to the heel becomes inflamed and the bone starts to crumble (a lot like osgood schlatters disease of the knee). Tight calf muscles may contribute as the range of motion at the ankle is reduced resulting in more strain on the achilles tendon. Sever's disease is the second most common injury of this type which is known as an apophysitis.
The typical clinical presentation is an active child (aged 9-10 years) who complains of pain at the posterior heel that is made worse by sports, especially those involving running or jumping. The onset is usually gradual. Often, the pain has been relieved somewhat with rest and consequently has been patiently monitored by the patient, parents, coaches, trainers, and family physicians, in the expectation that it will resolve. When the pain continues to interfere with sports performance and then with daily activities, further consultation is sought. It should be kept in mind that failure to instruct patients and parents that continual pain, significant swelling or redness, and fever are not signs of Sever disease and therefore require further evaluation could result in failure to diagnose a condition with much more serious long-term consequences.
Sever?s disease can be diagnosed based on the symptoms your child has. Your child?s doctor will conduct a physical examination by squeezing different parts of your child?s foot to see if they cause any pain. An X-ray may be used to rule out other problems, such as a broken bone or fracture.
Non Surgical Treatment
Decreasing or stopping sport is necessary until the pain reduces. Let pain be your guide, as it decreases you can slowly return to all activities. To help settle inflammation use an ice pack or rub an ice cube over the
painful area for 5 minutes daily whilst pain persists. Wearing supportive trainers during the day can help to soften the impact of walking on the heel. Encourage a normal pattern of walking. Complete the stretches below every day and before and after activity until your symptoms settle.
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.