Sever's disease or calcaneal apophysitis, is the most common cause of heel pain in the growing athlete and is due to overuse and repetitive microtrauma of growth plates of the calcaneus in the heel. It occurs in children ages 7 to 15, with the majority of patients presenting between 10 and 12 years of age.
The pain of Severs usually occurs because of inflammation and micro-trauma to the growth plate of the heel bone. This can be caused by a sudden increase in activity, running on very hard surfaces, a growth spurt, tight muscles or feet that roll in.
Pain is usually related to activity levels. In most cases the posterior aspect of the calcaneus will be tender. Checking both the medial and lateral aspects of the posterior portion of the growth plate will often show tenderness. Occasionally, the plantar aspect may be tender or both of these locations may be found to be tender. Frequently the Achilles tendon is tight and there may have been a recent increase in activity. The factors contributing to this disorder are similar to those causing plantar fasciitis, but a tight Achilles tendon appears to be a greater contributor than pronation.
The x-ray appearance usually shows the apophysis to be divided into multiple parts. Sometimes a series of small fragments is noted. Asymptomatic heels may also show x-ray findings of resporption, fragmentation and increased density. But they occur much less often in the normal foot. Pulling or ?traction? of the Achilles tendon on the unossified growth plate is a likely contributing factor to Sever?s disease. Excessive pronation and a tight Achilles and limited dorsiflexion may also contribute to the development of this condition.
Non Surgical Treatment
If your child suffers from Sever?s Disease, it is important you take him or her to see your podiatrist, as it can take some time for the condition to completely resolve. Possible treatment options for Sever?s disease may include. Rest from aggravating activities. Ice massage to reduce localised inflammation. Heel lifts placed inside the shoe to reduce the strain on the growth plate. Athletic footwear advice, poor footwear can sometimes be the major contributing factor in the development of Sever?s disease. Orthotic therapy, if your child has an abnormal foot posture that is contributing to the development of Sever?s disease, this will need to be treated with orthotic therapy. Orthotics for Sever?s disease may need to be prescription (custom-made) or non-prescription foot orthotics depending on your child?s foot posture, Exercise program, stretching exercises to improve flexibility of the leg muscles and strengthening exercises to address any foot muscle weakness or imbalance. Avoid barefoot walking, hill running and training on hard surfaces.
One of the most important things to know about Sever's disease is that, with proper care, the condition usually goes away within 2 weeks to 2 months and does not cause any problems later in life. The sooner Sever's disease is addressed, the quicker recovery is. Most kids can return to physical activity without any trouble once the pain and other symptoms go away.