Overview
As children reach their growth spurt in early puberty, the heel is one of the first body parts to grow to full size. Because children’s bones are growing so fast, the muscles or tendons can’t keep up and often become tight. The tight heel tendons can put a lot of stress on the heel, especially if a child is involved in athletics or other weight-bearing activity. Over time, too much pressure on the heel can injure it and result in Sever’s disease, also called calcaneal apophysitis.
Causes
Sever?s disease only occurs during a certain period of pre-adolescence, when the heel bone is going through a rapid growth spurt. In girls, this typically occurs around 8 to 10 years of age, and in boys, between ages 10 and 13. Sever?s disease is more common in active, athletic children. The condition is difficult to prevent completely, but changing the type and amount of physical activity when your child is experiencing pain will help.
Symptoms
Adolescents suffering from Sever?s disease usually complain of pain at the back of their heel which is often worse after exercising. It is most common between the ages of 10-12 in boys and 8-10 in girls due to the rapid growth spurts that occur during this time. It can however happen anytime up until the age of 15. Whilst most people present with pain worse in one foot, it is very common to have symptoms in both feet.
Diagnosis
Sever’s disease is diagnosed based on a doctor?s physical examination of the lower leg, ankle, and foot. If the diagnosis is in question, the doctor may order X-rays or an MRI to determine if there are other injuries that may be causing the heel pain.
Non Surgical Treatment
Treatment depends on the severity of the condition, but may include relative rest and modified activity, a physiotherapist can help work out what, and how much, activity to undertake. Cold packs, apply ice or cold packs to the back of the heels for around 15 minutes after any physical activity, including walking. Shoe inserts, small heel inserts worn inside the shoes can take some of the traction pressure off the Achilles tendons. This will only be required in the short term. Medication, pain-relieving medication may help in extreme cases, but should always be combined with other treatment and following consultation with your doctor). Anti-inflammatory creams are also an effective management tool. Splinting or casting, in severe cases, it may be necessary to immobilise the lower leg using a splint or cast, but this is rare. Time, generally the pain will ease in one to two weeks, although there may be flare-ups from time to time. Correction of any biomechanical issues, a physiotherapist can identify and discuss any biomechanical issues that may cause or worsen the condition. Education on how to self-manage the symptoms and flare-ups of Sever?s disease is an essential part of the treatment.
Exercise
Exercises that help to stretch the calf muscles and hamstrings are effective at treating Sever’s disease. An exercise known as foot curling, in which the foot is pointed away from the body, then curled toward the body in order to help stretch the muscles, has also proven to be very effective at treating Sever’s disease. The curling exercise should be done in sets of 10 or 20 repetitions, and repeated several times throughout the day.
Yong Schrauger 