Overview
Sever's disease, also called calcaneal apophysitis, is a painful bone disorder that results from inflammation (swelling) of the growth plate in the heel. A growth plate, also called an epiphyseal plate, is an area at the end of a developing bone where cartilage cells change over time into bone cells. As this occurs, the growth plates expand and unite, which is how bones grow. Sever's disease is a common cause of heel pain in growing kids, especially those who are physically active. It usually occurs during the growth spurt of adolescence, the approximately 2-year period in early puberty when kids grow most rapidly. This growth spurt can begin any time between the ages of 8 and 13 for girls and 10 and 15 for boys. Sever's disease rarely occurs in older teens because the back of the heel usually finishes growing by the age of 15, when the growth plate hardens and the growing bones fuse together into mature bone. Sever's disease is similar to Osgood-Schlatter disease, a condition that affects the bones in the knees.
Causes
The foot is one of the first body parts to grow to full size. During the time of growth, bones grow faster than muscles and tendons. This results in the muscles and tendons becoming tight. The strongest tendon that attaches to the heel is the Achilles Tendon. It attaches to the back of the heel at the site of the growth plate, and during sports activities it pulls with great force on the growth plate. If this pull by the tight Achilles Tendon (calf muscle) continues for long periods of time, the growth plate may become inflamed and painful. If exertive activities continue, Sever's Disease may result.
Symptoms
Typically, the sports injury occurs where the achilles tendon attaches to the bone. The epiphyseal growth plate is located at the end of a developing bone where cartilage turns into bone cells. As the growth center expands and unites, this area may become inflamed, causing severe pain when both sides of the heel are compressed. There is typically no swelling and no warmth, so it?s not always an easy condition to spot. The child usually has trouble walking, stiffness upon waking, and pain with activity that subsides during periods of rest.
Diagnosis
Sever?s disease can be diagnosed based on your history and symptoms. Clinically, your physiotherapist will perform a "squeeze test" and some other tests to confirm the diagnosis. Some children suffer Sever?s disease even though they do less exercise than other. This indicates that it is not just training volume that is at play. Foot and leg biomechanics are a predisposing factor. The main factors thought to predispose a child to Sever?s disease include decrease ankle dorsiflexion, abnormal hind foot motion eg overpronation or supination, tight calf muscles, excessive weight-bearing activities eg running.
Non Surgical Treatment
Treatment revolves around decreasing activity. Usual treatment has been putting children in a boot in slight equinus, or a cast with the foot in slight equinus, thereby decreasing the tension on the heel cord, which in turn pulls on the growth plate at the heel. As the pain resolves, children are allowed to go back to full activities. Complete resolution may be delayed until growth of the foot is complete (when the growth plate fuses to the rest of the bone of the heel). A soft cushioning heel raise is really important (this reduces the pull from the calf muscles on the growth plate and increases the shock absorption, so the growth plate is not knocked around as much). The use of an ice pack after activity for 20mins is often useful for calcaneal apophysitis, this should be repeated 2 to 3 times a day. As a pronated foot is common in children with this problem, a discussion regarding the use of long term foot orthotics may be important. If the symptoms are bad enough and are not responding to these measures, medication to help with inflammation may be needed. In some cases the lower limb may need to be put in a cast for 2-6 weeks to give it a good chance to heal.
Prevention
Because there are several theories as to the actual cause of the disease, there is no definitive answer on prevention. Experts agree, though, that youth athletes can help minimize the risk of Sever's disease by maintaining good joint and muscle flexibility while engaging in sports or physical activities.
Sever's disease, also called calcaneal apophysitis, is a painful bone disorder that results from inflammation (swelling) of the growth plate in the heel. A growth plate, also called an epiphyseal plate, is an area at the end of a developing bone where cartilage cells change over time into bone cells. As this occurs, the growth plates expand and unite, which is how bones grow. Sever's disease is a common cause of heel pain in growing kids, especially those who are physically active. It usually occurs during the growth spurt of adolescence, the approximately 2-year period in early puberty when kids grow most rapidly. This growth spurt can begin any time between the ages of 8 and 13 for girls and 10 and 15 for boys. Sever's disease rarely occurs in older teens because the back of the heel usually finishes growing by the age of 15, when the growth plate hardens and the growing bones fuse together into mature bone. Sever's disease is similar to Osgood-Schlatter disease, a condition that affects the bones in the knees.
Causes
The foot is one of the first body parts to grow to full size. During the time of growth, bones grow faster than muscles and tendons. This results in the muscles and tendons becoming tight. The strongest tendon that attaches to the heel is the Achilles Tendon. It attaches to the back of the heel at the site of the growth plate, and during sports activities it pulls with great force on the growth plate. If this pull by the tight Achilles Tendon (calf muscle) continues for long periods of time, the growth plate may become inflamed and painful. If exertive activities continue, Sever's Disease may result.
Symptoms
Typically, the sports injury occurs where the achilles tendon attaches to the bone. The epiphyseal growth plate is located at the end of a developing bone where cartilage turns into bone cells. As the growth center expands and unites, this area may become inflamed, causing severe pain when both sides of the heel are compressed. There is typically no swelling and no warmth, so it?s not always an easy condition to spot. The child usually has trouble walking, stiffness upon waking, and pain with activity that subsides during periods of rest.
Diagnosis
Sever?s disease can be diagnosed based on your history and symptoms. Clinically, your physiotherapist will perform a "squeeze test" and some other tests to confirm the diagnosis. Some children suffer Sever?s disease even though they do less exercise than other. This indicates that it is not just training volume that is at play. Foot and leg biomechanics are a predisposing factor. The main factors thought to predispose a child to Sever?s disease include decrease ankle dorsiflexion, abnormal hind foot motion eg overpronation or supination, tight calf muscles, excessive weight-bearing activities eg running.
Non Surgical Treatment
Treatment revolves around decreasing activity. Usual treatment has been putting children in a boot in slight equinus, or a cast with the foot in slight equinus, thereby decreasing the tension on the heel cord, which in turn pulls on the growth plate at the heel. As the pain resolves, children are allowed to go back to full activities. Complete resolution may be delayed until growth of the foot is complete (when the growth plate fuses to the rest of the bone of the heel). A soft cushioning heel raise is really important (this reduces the pull from the calf muscles on the growth plate and increases the shock absorption, so the growth plate is not knocked around as much). The use of an ice pack after activity for 20mins is often useful for calcaneal apophysitis, this should be repeated 2 to 3 times a day. As a pronated foot is common in children with this problem, a discussion regarding the use of long term foot orthotics may be important. If the symptoms are bad enough and are not responding to these measures, medication to help with inflammation may be needed. In some cases the lower limb may need to be put in a cast for 2-6 weeks to give it a good chance to heal.
Prevention
Because there are several theories as to the actual cause of the disease, there is no definitive answer on prevention. Experts agree, though, that youth athletes can help minimize the risk of Sever's disease by maintaining good joint and muscle flexibility while engaging in sports or physical activities.