Overview
Another name for Sever?s Disease is calcaneal apophysitis. The heel bone is called the calcaneus. Sever?s Disease is heel pain thought to be caused by inflammation around the growth plate in the calcaneus (apophysis). It is most likely due to repetitive overuse during sports and exercise, which causes increased strain on the heel growth plate. Sever?s Disease won?t cause long-term damage or arthritis. Sever?s Disease is often associated with tight heel tendons. It most commonly affects physically active children who are between the ages of 8, 14 years old, such as soccer players and gymnasts.
Causes
Apart from age, other factors that may contribute to developing Sever?s disease include physical activity, any form of exercise that is weight bearing through the legs or stresses the soft tissue can exacerbate the pain of the disease. External factors, for example, running on hard surfaces or wearing inappropriate shoes during sport. Overuse injury, very active children may repeatedly but subtly injure the bones, muscles and tendons of their feet and ankles. In time, the accumulated injuries cause symptoms.
Symptoms
The patient complains of activity related pain that usually settles with rest. On Examination the heel bone - or calcaneum - is tender on one or both sides. The gastrocnemius and soleus muscles (calf muscles) may be tight and bending of the ankle might be limited because of that. Foot pronation (rolling in) often exacerbates the problem. There is rarely anything to see and with no redness or swelling and a pain that comes and goes mum and dad often wait before seeking advice on this condition. The pain may come on partway through a game and get worse or come at the end of the game. Initially pain will be related only to activity but as it gets worse the soreness will still be there the next morning and the child might limp on first getting up.
Diagnosis
Physical examination varies depending on the severity and length of involvement. Bilateral involvement is present in approximately 60% of cases. Most patients experience pain with deep palpation at the Achilles insertion and pain when performing active toe raises. Forced dorsiflexion of the ankle also proves uncomfortable and is relieved with passive equinus positioning. Swelling may be present but usually is mild. In long-standing cases, the child may have calcaneal enlargement.
Non Surgical Treatment
There are several things we can do to treat Sever?s disease and ease the discomfort. Special shoe inserts, such as heel pads or cups, can act as a shock absorber, decrease pressure on the heel bone and slightly elevate the heel to relieve the pain. Elastic wraps and compression stockings can help decrease any swelling and pain. We also show kids some specific stretches that can help stretch the calf muscles and tendons on the back of the leg to reduce stress on the heel. We might also recommend rest, applying ice, elevating the foot, and over-the-counter pain medication.
Recovery
It may take several weeks or months for the pain to completely stop. When the pain is completely gone, your child may slowly return to his or her previous level of activity.
Another name for Sever?s Disease is calcaneal apophysitis. The heel bone is called the calcaneus. Sever?s Disease is heel pain thought to be caused by inflammation around the growth plate in the calcaneus (apophysis). It is most likely due to repetitive overuse during sports and exercise, which causes increased strain on the heel growth plate. Sever?s Disease won?t cause long-term damage or arthritis. Sever?s Disease is often associated with tight heel tendons. It most commonly affects physically active children who are between the ages of 8, 14 years old, such as soccer players and gymnasts.
Causes
Apart from age, other factors that may contribute to developing Sever?s disease include physical activity, any form of exercise that is weight bearing through the legs or stresses the soft tissue can exacerbate the pain of the disease. External factors, for example, running on hard surfaces or wearing inappropriate shoes during sport. Overuse injury, very active children may repeatedly but subtly injure the bones, muscles and tendons of their feet and ankles. In time, the accumulated injuries cause symptoms.
Symptoms
The patient complains of activity related pain that usually settles with rest. On Examination the heel bone - or calcaneum - is tender on one or both sides. The gastrocnemius and soleus muscles (calf muscles) may be tight and bending of the ankle might be limited because of that. Foot pronation (rolling in) often exacerbates the problem. There is rarely anything to see and with no redness or swelling and a pain that comes and goes mum and dad often wait before seeking advice on this condition. The pain may come on partway through a game and get worse or come at the end of the game. Initially pain will be related only to activity but as it gets worse the soreness will still be there the next morning and the child might limp on first getting up.
Diagnosis
Physical examination varies depending on the severity and length of involvement. Bilateral involvement is present in approximately 60% of cases. Most patients experience pain with deep palpation at the Achilles insertion and pain when performing active toe raises. Forced dorsiflexion of the ankle also proves uncomfortable and is relieved with passive equinus positioning. Swelling may be present but usually is mild. In long-standing cases, the child may have calcaneal enlargement.
Non Surgical Treatment
There are several things we can do to treat Sever?s disease and ease the discomfort. Special shoe inserts, such as heel pads or cups, can act as a shock absorber, decrease pressure on the heel bone and slightly elevate the heel to relieve the pain. Elastic wraps and compression stockings can help decrease any swelling and pain. We also show kids some specific stretches that can help stretch the calf muscles and tendons on the back of the leg to reduce stress on the heel. We might also recommend rest, applying ice, elevating the foot, and over-the-counter pain medication.
Recovery
It may take several weeks or months for the pain to completely stop. When the pain is completely gone, your child may slowly return to his or her previous level of activity.