Sever’s disease (Heel Pain in Adolescents and Children)
Sever’s disease is a condition common amongst children and adolescents. It is characterized by pain at the heel, mild swelling and limping or difficulty in walking
Often called growing pains, this condition occurs usually occurs when a child undergoes a growth spurt. The name growing pains suggests that there is no treatment for severs disease however there are a number of options available that will help to limit the pain of severs disease.
What happens to the foot?
The calcaneus is the large bone in the foot which forms a major portion of the heel. In the case of Severs disease, the growing part of the heel bone becomes inflamed. This condition is also known as calcaneal apophysitis (severs disease).
As most bones grow in adolescents and children, there is a plate of growth known as the growth plate or apophysis. Repeated strain and stress at the joint between the growth plate and the rest of the bone leads to inflammation of the region called the apophysitis.
Common reasons for predisposition to Sever’s disease include over pronation, tight tendons of the foot and lower limb, rapid growth of the foot (seen in adolescence), poor footwear and repeated small injuries to the back of heel. There can sometimes be extra bone spurs at this area or even tiny fractures that occur due to the stress and injury to the bone.
Some children are more susceptible to this condition and other similar problems of the knee (Osgood Schaltter’s disease), elbow (little leaguer’s elbow) or hips (iliac apophysitis). These children are unable to bear the stress and strain of exercise, especially at the joint between the growth plate and the rest of the bone.
Typical clinical picture of severs disease
In Sever’s disease, a common picture presented to the podiatrist is that of an active child, aged between 9 and 10 (sometimes up to 15 years), complaining of heel pain, which is made worse by sports like running and jumping. Initially, the pain goes away with rest and is slow to increase in intensity. In 60 percent of the cases, it affects both heels. This condition is seen more commonly in adolescent boys than girls.
Sever’s disease differs from typical adult heel pain or plantar fascitis. In the latter condition, adults often feel the pain coming on after getting out of bed or after rest. The pain subsides after bearing weight or walking around a bit. Sever’s disease, on the other hand, gets aggravated by weight bearing or exercise like running or jumping.
Long term consequences of severs disease
Severes disease is a painful and debilitating condition that will often progressto become more painful with continued activity. With treatment Sever’s disease is often resolves within two to eight weeks or once the foot has finished growing. The condition, however, can come back with the start of more physical activities or sports. The condition will not affect the child’s future athletic performance.
How to treat and prevent severs disease
Regular stretching exercises can keep the growing foot supple and flexible. Running or jumping on hard surfaces especially wearing shoes low heel and with thin hard soles can bring on the pain. Shoes should be well fitted and should have shock absorbing midsoles. When there is onset of pain, an ice pack applied to the heel for 5 to 10 minutes can bring relief.Orthotic innersoles help to control the abnormal movements pronation”>(pronation) of the foot that can aggravate the growth centre of the heel.
Rest – One way to reduce the symptoms of severs disease is to avoid or modify those activities, which aggravate the condition like running and jumping type sports.
Ice – Ice will help reduce inflammation in to the area and will also help to reduce pain involved with the injury.Ice should be applied for 10 minutes 3 times per day.
Foot Strapping– Strapping helps correct any mechanical abnormalities in your feet that will affect your lower limb function.If strapping has reduced the amount of severs disease related heel pain then an insole can be uses as permanent measure.
Shoes – a well fitted shoe is necessary to support the foot and limit any abnormal motions like pronation.A shoe with a firm but shock absorbing dual density midsole is usually beneficial.For more information see you “good things to look for in a shoe” page.Shoes with a low heel (football boots) will also aggravate this condition.
Stretching Strengthening – A specific exercise program stressing calf muscle stretching and strengthening is necessary to speed recovery.
Innersoles – innersoles are used when there is a mechanical deformity in the bony structure of the foot (usually causes rolling in or pronation). innersoles balance the foot which allows it to function more efficiently. When the foot rolls in this places excess strain on the growing region of the heel causing calcaneal apophysitis (severs disease).A soft yet supportive insole is ideal for treatment of Severs disease as it will support and cushoin the heel.
The Ergonx ultra soft is the perfect insole for the treatment of Severs disease.