Sever?s Disease (calcaneal aphophysitis) is not really a disease, but more a repetitious strain injury. This is the most common cause of kids heel pain seen at Podiatry Care. Active children in football, soccer, basketball, netball and tennis with this type of foot pain complain of pain in the region of the heel bone particularly after exercise. In severe cases, children will complain of pain during exercise as well. It is a frequent cause of heel pain in children, particularly in the very active child. It is most often seen in children between the ages of 8 to 15 years as the growth plate is not fully developed or calcified at this time.
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.
Sever’s Disease is most commonly seen in physically active girls and boys from ages 10 to 15 years old. These are the years when the growth plate is still “”open,”” and has not fused into mature bone. Also, these are the years when the growth plate is most vulnerable to overuse injuries, which are usually caused by sports activities. The most common symptoms of this disease include. Heel pain in one or both heels. Usually seen in physically active children, especially at the beginning of a new sports season. The pain is usually experienced at the back of the heel, and includes the following areas. The back of the heel (that area which rubs against the back of the shoe). The sides of the heel. Actually, this is one of the diagnostic tests for Sever’s Disease, squeezing the rear portion of the heel from both sides at the same time will produce pain. It is known as the Squeeze Test.
This can include physical examination and x-ray evaluation. X-rays may show some increased density or sclerosis of the apophysis (island of bone on the back of the heel). This problem may be on one side or bilateral.
Non Surgical Treatment
The treatment of Sever’s disease depends upon the severity of symptoms experienced by the patient. Care is initiated with a simple program of stretching and heel elevation to weaken the force applied to the calcaneus by the Achilles tendon. If stretches and heel elevation are unsuccessful in controlling the symptoms of Sever’s disease, children should be removed from sports and placed on restricted activities. Mild Symptoms. Wear a 3/8 heel lift at all times (not just during physical activity). It is important to use a firm lift and not a soft heel pad. Calf stretches 6/day for 60 seconds each. Calf stretches are best accomplished by standing with the toes on the edge of a stretching block. Moderate Symptoms. Follow the directions for minor symptoms and decrease activity including elimination of any athletic activity. In addition to stretching by day, a night stretching splint can be worn while sleeping. Severe Symptoms. Follow the directions for mild and moderate symptoms. Children should be removed from sports activities such as football, basketball, soccer or gym class. A below knee walking cast with a heel lift or in severe cases, non-weight bearing fiberglass cast, may be indicated for 4-6 weeks. The cast should be applied in a mildly plantar flexed position. Cam Walkers should not be used for Sever’s Disease unless they have a built in heel lift.
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.