Heel pain and severs disease

If your child is around age 9, you’ve probably heard of Severs Disease. What is this serious-sounding heel pain and why is it so common these days?

Severs disease is a condition causing heel pain around the sides and back of the heel, usually affecting young adolescents. Although considered a more modern problem, the condition was first described back in 1912 by Dr Sever in the USA. Its incidence has increased as children participate more intensely in organised sports at higher levels than previous generations.

This condition usually affects very active children, particularly those who compete in running or jumping sports, such as soccer, rugby, netball, basketball and gymnastics. It can first appear in children from age 7, with most cases falling into the 9- to 12-year-old range. If your child suffers from this, you’ll both be relieved to know that at around 12- to 14-years, the growth centre in the heel matures and fuses to the heel bone. Once this happens, Severs disease will no longer be an issue.

The typical case is where heel pain develops slowly and occurs with activity. Usually just one heel is involved, but both heels can be affected at the same time. The pain is sometimes described as “feeling like a bruise” and is made worse on side to side squeezing of the heel. There is usually no swelling in the area and no visible bruising. Often the pain level is high enough to cause limping. The pain is usually worse with barefoot activity or running in shoes with limited heel heights, cushioning or arch support. The pain usually reduces with rest or doing lower impact sports.

Some studies have shown that children with tight calf muscles are more prone to getting this condition, so it is important to follow a gradual stretching programme and maintain calf exibility. It is also very important to build up activity levels and not go from “zero to hero”.

While most cases are mild, it is best to assess and treat early. Sometimes pain levels become such that a child might have to stop playing sport altogether.

Remember though, not all heel pain is Severs disease, so it is important to have your child professionally assessed, diagnosed and prescribed the correct treatment programme.

 

Treatment can include:

Rest and modification of activity:

Reduce running and high impact sports to rest the heel and allow it to settle. Try and substitute with low impact cross-training activities such as cycling, swimming or rowing.

Reducing inflammation:

Applying an ice pack to the site for 15 minutes will help reduce the symptoms.

Calf stretching:

Increase calf exibility by doing 3 sets of calf stretches (on both sides) for 20-30 seconds a couple of times a day.

Shoe inserts:

A podiatrist can help fit heel lifts and arch supports to reduce strain.

Taping:

A podiatrist can apply and demonstrate the use of firm taping across the growth plate area which other family members can do at home before a strenuous training session or game.

Footwear:

It is important to have a podiatrist review the footwear that is used for sport and advise on appropriate changes.

 

Technically speaking

Severs disease is an irritation of the growth plate (Calcaneal Apophysis) in the back of the heel. The cause of the irritation is usually mechanical stress through and across the growth plate. The Achilles tendon attaches to the top of the growth plate and a strong ligament (the Plantar Fascia) attaches to the front of the growth plate. When too great a level of force and strain is exerted through the growth plate, pain develops and Severs disease (also known as Calcaneal Apophysitis) is diagnosed.

By Gordon Williams
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