What is it?
Sever’s disease is basically an injury of the bone in which the cord of the heel becomes inflamed thereby leading to pain. This disease is known to commonly affect young children mostly those children who are very much active physically. This disease is also known as Calcaneal apophysitis. This condition is known to be very much similar to Osgood-Schlatter medical condition, which is a condition that tends to affect the bones present in the knee.
It is a serious type of growing pain. The fact is that the rate at which the heel bones grow in a child is slow compared to the growth rate of the ligaments of the leg. In the human body the heel bone is the first one that reaches to full size and since it is not flexible and elastic it does not reach full size. As the heel bone is going through a growth spurt, the Achilles tendon due to its slow growth rate may struggle to catch up with it.
The Achilles tendon connects the calf muscle to the heel. In this condition the tendon and the leg muscles can become tight, strained and over stretched. Repetitive pressure is placed on the tendon as the child walks, runs or plays and the growing heel bone can get damaged due to the tension which may result in inflammation and pain.
This disease is mostly caused due to a mismatch in the development of the bone, calf muscles as well as the Achilles tendon. In case of a growth spurt, the heels of the child would start to grow faster than its tendons, ligaments or muscles of the leg. It is said that the heels are known to be the child’s first part of the body which reaches its complete adult size quickly.
But the muscles and the tendons do not grow faster to keep up with the heels hence they get stretched too much tight. When the child is active, mostly when the child is involved in any kind of sports activity that involves a lot of running or jumping around on the hard surfaces then it can lead to extra strain on those already overstretched tendons thereby leading to swelling as well as pain at that point where the tendons get attached to the growing part of the heel.
The various symptoms an individual would experience are pain in the heels, swelling, stiffness in the calf muscles, limping, tenderness, there is a tendency to tiptoe and the pain would worsen post an exercise. There can feeling of tightness, or tenderness at the back of the heel which may feel worse when that particular area is squeezed. The individual may find it difficult to walk around.
There would be heel pain which may get worse post running or jumping around and would start to feel better when the individual rests. During the beginning of the sports this pain may feel bad. It can also feel worsen while wearing a hard or stiff shoes such as those soccer cleats.
Who is at risk?
There are various risk factors that can contribute to this disease are carrying out physical activity, overuse of an injury and other external factors. This disease is commonly seen in boys since they tend to mostly have later growth spurts. They get this condition typically between the age of ten to fifteen years. In case of girls, this disease is known to occur mostly between the age of 8 to 13 years.
Typically, boys and girls between the ages of 8 and 15 are affected by Sever’s disease. These include:
Athletic activity- this includes those involved in track, gymnastics, soccer, ballet, ice skating and aerobics in which the heel comes into contact with the hard surfaces.
For every child well made shoes that fit properly should be used since ill fitting shoes can increase the risk
Standing for longer periods of time for choir practice, doing dishes, or any other activity can on the heel bone can increase the risk.
The doctor would be able to diagnose the disease by firstly carrying out a physical examination, the symptoms would be assessed by carrying various tests or scans such as X-Ray so as to rule out the possibility of any other medical condition.
The doctor would thoroughly examine the heels of the child and ask about the activity level of the child or whether he or she participates in any sports activity. They may also carry out the squeeze test wherein they would squeeze the behind portion of the heel from both the sides at the same time for checking if by squeezing it is leading to any kind of pain.
This disease can be treated effectively by using cold packs, shoe inserts, pain relief medication, splinting or using casting or correction of any kind of biomechanical issues. This disease cannot be termed as serious since it is mostly self-limiting and would rarely lead to any kind of long-term issues.
Carrying out stretching or strengthening exercises would also help but it should be carried out under the guidance of a physical therapist to avoid any other kind of pain. The doctor can recommend to carry out ice packs or use NSAIDs for example ibuprofen or naproxen for getting relief from pain. In case if the condition turns out to be severe then the child would need to be on cast or the heel would be forced to take rest.
- Schedule an appointment with the doctor if your child complains of heel pain. You may or may be referred to a podiatrict by the family doctor. One of the following steps should be included in the treatment of Sever’s disease:
- Physical activity should be reduced- since in athletic children, Sever’s disease appears to be most common hence the pressure on the heel bone can be reduced by reducing exercise periods. This will also reduce the pain. Your doctor may recommend that for a set amount of time your child needs to take break from athletic activity.
- Icing-both the inflammation and pain levels can be reduced by icing the heel. To the heel apply ice wrapped in a towel or use ice packs.
- New exercise regimen- to lengthen the calf muscles and tendons do simple stretches.
- Orthotic shoe inserts- to help your child maintain a good level of physical activity the doctor may prescribe use of these shoe inserts. An excellent option is HTP heel seats that many parents have found to be an effective aid for their children
- Plaster cast- the doctor may recommend plaster cast or boot but only in extreme cases and only if other solutions fail.
- Anti inflammatory medications can be prescribed by some doctor. But before using them seek the doctor’s advice.
- Oscon- this is an oral supplement and it is being actually marketed for those suffering from conditions of overuse syndrome such as Osgood Schlatter disease or Sever’s disease or another other such condition in which the bones in the knees are affected. It contains natural form of vitamin E, organic selenium compounds and Saccharomyces cerevisae.
- Iontophoresis- to give medicines through the skin a small laser is sued and in this procedure a needle is not required. For his treatment, further scientific research is required.
- Crutches- in severe cases crutches can be used or in cases in which the pain is bilateral/
- Partial apophysectomy- in extreme circumstances the apophysis of the calceneus may be partially removed.
In some cases, when the child reaches a certain age the condition can be outgrown by the child but this does not mean that when the child is experiencing symptoms it should be ignored. They should be taken seriously when they experience serious pain. Sever’s disease should not be left untreated and this condition is indicated by heel pain. If not treated it can damage the growing heel bones. The first step to take in receive a diagnosis of symptoms is by scheduling a doctor’s appointment.
Any other related conditions:
Few of the other possible causes of pain in the heels can be attributed to plantar fascilitis, achillies tendonitis, bursitis and stress fracture.
Those who suffer from sever’s disease can take help from a physiotherapist, orthopaedist or a podiatrist for treating it.
Will stretching exercises help?
It can help and it is important. Through this exercise the child will stretch the tendon on the back of the leg, calf muscles and the hamstring. At least two or three times a day the child should do these stretches with each held for about 20 seconds. Even if the pain is only in one heel but both legs should be stretched. Even the muscles on the front of the shin should be strengthened by doing exercises.
For this let your child sit on the floor, let the child keep the affected leg straight. Around a table one end of a bungee cord or piece of rubber tubing is hooked and around the child’s toe the other end is hitched. The child will scot back just so that he or she is able to stretch the cord. Next the foot is slowly bent towards the body. The child will slowly point the foot in the opposite direction when he or she is unable to bend the foot any closer. About three times the child should do this exercise and a few times daily on routine basis the child should do this exercise.
Your child should start feeling better within two weeks to two months if proper care is taken. Only when the heel pain is gone completely the child can start playing sports. You can discuss with the doctor when is the physical activity safe for your child.
With Sever’s disease no long term problems are associated. However, if the heel pain does not get better then call your doctor or if you notice that there is swelling or the skin color has changed or the condition is becoming worse then call your doctor.
- Modification of physical activity- by using caution during physical activity the symptoms can be alleviated or reduced or the condition can be prevented. When doing physical activity that involves running and jumping the child should exercise caution. The child should avoid running on surfaces that are hard.
- Stretching or strengthening exercises- to help stretch and strengthen muscles, tendons, heel and the leg specific exercises such as heel lifts can be beneficial.
- Supportive footwear- to help prevent onset of symptoms high quality shoes with specific features may help such as shoes that can provide adequate arch support.