Sever's disease is a common cause of heel pain, particularly in the young and physically active. During puberty the calcaneus consist of two areas of bone known as ossification centres. These two
areas are divided by an area of cartilage known as the calcaneal apophysitis. See x-ray (right) for two ossification centres of heel. The Achilles tendon attaches the triceps surae (calf muscles) to
the calcaneus (heel bone). As a child grows the calcaneus grow faster than the surrounding soft tissue, which means the Achilles tendon is pulled uncomfortably tight. This increase in tensile load
can cause inflammation and irritation of the calcaneal apophysis (growth plate) which is known as Sever's Disease. The pain is exacerbated by physical activities, especially ones involving running or
jumping. Sever's disease most commonly affects boys aged 12 to 14 years and girls aged 10 to 12 years, which corresponds with the early growth spurts of puberty.
During the growth spurt of early puberty, the heel bone sometimes grows faster than the leg muscles and tendons. This can cause the muscles and tendons to become very tight and overstretched, making
the heel less flexible and putting pressure on the growth plate. The Achilles tendon is the strongest tendon that attaches to the growth plate in the heel. Over time, repeated stress, from physical
activities and sports, on the Achilles tendon damages the growth plate, causing the swelling, tenderness, and pain of Sever's disease.
If your child is suffering from this disease they will be experiencing pain and tenderness in the back of their foot. This soreness can also extend to the sides of the feet. Other sure signs of this
disorder include swelling and sensitivity to touch. Because of the amount of discomfort, your child may find it difficult to walk or run. Pay attention to the way your child is walking. If you notice
unusual posture or abnormal gait they may be avoiding placing pressure on the heel. These symptoms typically become apparent during activity and exercise or directly following it. If your child is
indicating pain in their heel, schedule an appointment with us today.
Most often, a healthcare professional can diagnose Sever?s disease by taking a careful history and administering a few simple tests during the physical exam. A practitioner may squeeze the heel on
either side; when this move produces pain, it may be a sign of Sever?s disease. The practitioner may also ask the child to stand on their tiptoes, because pain that occurs when standing in this
position can also be an indication of Sever?s disease.
Non Surgical Treatment
The disease can be treated easily and is considered to be temporary, if treated promptly and correctly. If left untreated or if treated improperly, the disease can result in a permanent heel
deformity, causing future shoe-fitting difficulties. Other long-term effects can include foot arch problems, potentially resulting in plantar fasciitis or heel spurs and tight calf musculature, which
can lead to Achilles tendonitis. The American College of Foot and Ankle Surgeons recommends the following steps, once Sever?s disease has been diagnosed. Reduce or stop any activity that causes pain.
Temporary shoe inserts or custom orthotic devices may provide support for the heel. Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may help reduce the pain and inflammation.
Stretching and/or physical therapy may be used to promote healing. In severe cases, a cast may be used to keep the foot and ankle immobilized during the healing process.
To prevent Sever's Disease, fit your child with kid's shoes with good cushioning in the footbed, shock absorption in the heel, and support in the outsole. Make sure children wear supportive shoes,
especially when they're running and jumping, to reduce the impact on the heel and strain on the developing bone and muscle structure of a kids' feet. Children's arch supports and heel cups
comfortably support the foot and encourage healthy alignment while your child runs or walks.