Sever’s disease is a common heel injury occurring in children. This can be a very painful diagnosis as a result of calcaneal apophysitis, or inflammation of the growth plate located in the heel bone. This disease usually occurs during the child’s growth spurt into adolescence over the course of 2 years when the child is growing the most rapidly. The growth spurt usually occurs between the ages of 8 to 13 for girls, and 10 to 15 for boys. It is not usually diagnosed in children older than 15 years of age because the growth plate has usually fused (as it should) by this time.
Sever’s is commonly seen in the active child as well as a result of increased tightness of the Achilles tendon which attaches into the growth plate of the calcaneus and decreases range of motion at the ankle. Repeated stress to the Achilles tendon, such as running and jumping, can damage the growth plate resulting in pain, inflammation and swelling. Improper footwear can also lead to Sever’s due to lack of support for the child who over pronates (flatfoot), has a high arch, has a short leg (usually a congenital defect, or can be traumatic in nature as well) or who is overweight.
The signs and symptoms of Sever’s include:
• Swelling and redness in the heel
• Difficulty walking
• Discomfort or stiffness in the feet upon awaking
• Discomfort when the heel is squeezed on both sides
• An unusual walk, such as walking with a limp or on tiptoes to avoid putting pressure on the heel
Diagnosis includes subjective reports of the child to what activities increase symptoms and what activities decrease symptoms. An x-ray can also be taken to rule out fractures as needed, but is not standard procedure because Sever’s is not seen on x-ray.
Treatment of Sever’s is performed with the goal of pain relief for the child. Rest is the most beneficial treatment, but other treatment will be administered to speed up the recovery process including:
• Gastroc and soleus stretching to increase Achilles tendon flexibility
• “Duck walks” to improve ankle mobility
• Isolated foot and ankle strengthening with a focus on eccentrics (lengthening contractions)
• Core and gluteal exercises to improve lumbo-pelvic stability and improve alignment of the hip, knee and ankle improving functional foot mechanics
• Orthotics if a severe mechanical deformity is present that cannot be controlled with just strengthening and stretching
• Ice and elevation to decrease inflammation and swelling
• Night splint to keep the ankle in neutral dorsiflexion to maintain Achilles tendon flexibility
If you believe your child may be suffering from Sever’s disease, schedule an appointment with one of our practitioners to start the healing process. The longer the child is in pain, the longer the duration of treatment until full resolution of symptoms.