Sever's Disease, also known as calcaneal apophysitis, is a disease of the growth plate of the heel bone (calcaneus) and is characterized by pain in the heel of a child's foot, typically brought on by some form of injury or minor trauma from sports participation. This condition is most common in children ages 9 to 14 and is frequently seen in active soccer, football, or baseball players. Sport shoes with cleats are also known to aggravate the condition. The disease can mimic Achilles tendonitis, an inflammation of the tendon attached to the back of the heel. A tight Achilles tendon contributes to Sever's Disease by pulling excessively on the growth plate of the heel bone. Feet that flatten out to excess (hyperpronate) are also prone to this problem, as this can involve extra torque on the calcaneus by the Achilles tendon.
Apart from age, other factors that may contribute to developing Sever?s disease include physical activity, any form of exercise that is weight bearing through the legs or stresses the soft tissue can exacerbate the pain of the disease. External factors, for example, running on hard surfaces or wearing inappropriate shoes during sport. Overuse injury, very active children may repeatedly but subtly injure the bones, muscles and tendons of their feet and ankles. In time, the accumulated injuries cause symptoms.
Most children with Sever's complain of pain in the heel that occurs during or after activity (typically running or jumping) and is usually relieved by rest. The pain may be worse when wearing cleats. Sixty percent of children's with Sever's report experiencing pain in both heels.
Sever's disease is based on the symptoms reported. To confirm the diagnosis, the clinician will examine the heels and ask about the child's activity level and participation in sports. They may also squeeze the back part of the heel from both sides at the same time to see if doing so causes pain and also ask the child to stand on tiptoes to see if that position causes pain. There may be tightness in the calf muscle, which contributes to tension on the heel. Symptoms are usually worse during or after activity and get better with rest. X-rays generally are not that helpful in diagnosing Sever's disease, but they may be ordered to rule out other problems, such as fractures. Sever's disease cannot be seen on an X-ray.
Non Surgical Treatment
Treatment may consist of one or more of the following, Elevating the heel, Stretching hamstring and calf muscles 2-3 times daily, Using R.I.C.E. (Rest, Ice, Compression, Elevation), Foot orthotics, Medication, Physical therapy, Icing daily (morning), Heating therapy, Open back shoe are best and avoid high heel shoe. The Strickland Protocol has shown a positive response in patients with a mean return to sport in less than 3 weeks.
One of the most important things to know about Sever's disease is that, with proper care, the condition usually goes away within 2 weeks to 2 months and does not cause any problems later in life. The sooner Sever's disease is addressed, the quicker recovery is. Most kids can return to physical activity without any trouble once the pain and other symptoms go away. Although Sever's disease generally heals quickly, it can recur if long-term measures are not taken to protect the heel during a child's growing years. One of the most important is to make sure that kids wear proper shoes. Good quality, well-fitting shoes with shock-absorbent (padded) soles help to reduce pressure on the heel. The doctor may also recommend shoes with open backs, such as sandals or clogs, that do not rub on the back of the heel. Shoes that are heavy or have high heels should be avoided. Other preventive measures include continued stretching exercises and icing of the affected heel after activity.