Sever?s disease (sometimes called Sever disease) is a common cause of heel pain, particularly in the young and physically active. It usually develops just before puberty. Boys are slightly more prone
to this condition than girls. Physiotherapy can help manage the symptoms of Sever?s disease so that the young person can continue to take part in physical activity. Another name for Sever?s disease
is calcaneal apophysitis.
Severs disease is often associated with a rapid growth spurt. As the bones get longer, the muscles and tendons become tighter as they cannot keep up with the bone growth. The point at which the
achilles tendon attaches to the heel becomes inflamed and the bone starts to crumble (a lot like osgood schlatters disease of the knee). Tight calf muscles may contribute as the range of motion at
the ankle is reduced resulting in more strain on the achilles tendon. Sever's disease is the second most common injury of this type which is known as an apophysitis.
Children aged between 8 to 13 years of age can experience Sever?s disease with girls being normally younger and boys slightly older. Sever?s disease normally involves the back of the heel bone
becoming painful towards the end of intense or prolonged activity and can remain painful after the activity for a few hours. Severe cases can result in limping and pain that can even remain the next
morning after sport.
All medical diagnosis should be made by taking a full history, examining the patient then performing investigations. The problem usually occurs in boys who are going through or have just gone through
a growth spurt; one or both heels may be affected. Initially the pain may be intermittent occurring only during or after exercise. As the problem gets worse, pain may be present most of the time.
There may be swelling over the back of the heel and this area is painful if touched or knocked. On examination the patient often has flat feet, very tight legs muscles especially the
Non Surgical Treatment
Treatment for Sever?s disease is mainly supportive, to stop inflammation and reduce pain. The condition will resolve on its own when the growth in the growth plate is complete, but until then,
measures can be taken to resolve pain and discomfort. Applying ice to the painful or swollen areas on the foot may provide some short-term relief from pain and prevent further inflammation. Ice can
be applied for about 20 minutes two or three times a day. Footwear that is too big, too small, or does not provide proper support can exacerbate the symptoms of Sever?s disease. Supportive footwear
is important to prevent discomfort, especially in children who participate in sports and activities that take place on a hard surface (such as pavement or a basketball court). Shoes should also have
adequate padding and not rub against the heel. In some cases, shoes that do not have heels (such as sandals) may be more comfortable to wear while the heel is healing, but care should be taken that
the shoe provides proper support to the rest of the foot. Children with Sever?s disease should avoid going barefoot.Children with flat feet, high arches, or over-pronation may need treatment to
resolve these underlying conditions. In many cases, an orthotic worn inside the shoe can help put the foot into a better alignment and provide relief to the foot or the arch. Children who are
overweight or obese may be counseled to lose weight. Being overweight can contribute to the development of several conditions, including Sever?s disease. Resting the foot and discontinuing sports and
other activities until the pain and stiffness is resolved may be recommended. In extreme cases, a walking boot or a cast might be used to completely immobilize the foot. A physical therapist may
recommend stretching exercises for the muscles in the calf and the Achilles tendon. A stretching routine is usually done several times a day. Stretching these muscles can help improve strength and
decrease the stress on the heel plate. Some physicians may recommend over-the-counter pain relievers such as ibuprofen or acetaminophen. Care must be taken when administering these medications to
children, especially with acetaminophen, as overdoses are possible when using more than one medication containing acetaminophen. Aspirin should never be given to children. The utility of pain
relievers in children must be weighed against their possible side effects. For small variations-less than an inch or so-shoe lifts can help equalize the length of the legs. In cases with more
variation between legs, surgical solutions may be considered. Research indicates that targeted manual therapy techniques performed by a licensed physical therapist can help to reduce pain from
Sever?s Disease and to improve muscle function. When the larger calf muscles and the smaller ankle and foot muscles become tight, this tightness can affect the mechanics of the ankle joint. Manual
therapy includes both joint and muscle release techniques to restore optimal function to the calf, ankle, and foot muscles, and results can generally be achieved within a few months.
The surgeon may select one or more of the following options to treat calcaneal apophysitis. Reduce activity. The child needs to reduce or stop any activity that causes pain. Support the heel.
Temporary shoe inserts or custom orthotic devices may provide support for the heel. Medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, help reduce the pain and
inflammation. Physical therapy. Stretching or physical therapy modalities are sometimes used to promote healing of the inflamed issue. Immobilization. In some severe cases of pediatric heel pain, a
cast may be used to promote healing while keeping the foot and ankle totally immobile. Often heel pain in children returns after it has been treated because the heel bone is still growing. Recurrence
of heel pain may be a sign of calcaneal apophysitis, or it may indicate a different problem. If your child has a repeat bout of heel pain, be sure to make an appointment with your foot and ankle