Sever’s disease occurs in children when the growth plate (which is the growing part of the heel) is injured. The foot is one of the first body parts to grow to full size. This usually occurs in early puberty. During this time, bones often grow faster than muscles and tendons. As a result, muscles and tendons become tight. The heel area is less flexible. During weight-bearing activity (activity performed while standing), the tight heel tendons may put too much pressure at the back of the heel (where the Achilles tendon attaches). This can injure the heel and cause Sever’s disease.
Sever’s disease is caused by repetitive tension and/or pressure on the growth center of the heel. Running and jumping place a large amount of pressure on the heels and can cause pain. Children with Sever’s may limp or have an altered gait due to the pain. Risk factors for Sever’s include tight calf muscles, weak ankle muscles, and alignment abnormalities at the foot and ankle. Sever’s can also result from wearing shoes without sufficient heel padding or arch support.
The most prominent symptom of Sever’s disease is heel pain which is usually aggravated by physical activity such as walking, running or jumping. The pain is localized to the posterior and plantar side of the heel over the calcaneal apophysis. Sometimes, the pain may be so severe that it may cause limping and interfere with physical performance in sports. External appearance of the heel is almost always normal, and signs of local disease such as edema, erythema (redness) is absent. The main diagnostic tool is pain on medial- lateral compression of the calcaneus in the area of growth plate, so called squeeze test. Foot radiographs are usually normal. Therefore the diagnosis of Sever’s disease is primarily clinical.
Sever condition is diagnosed by detecting the characteristic symptoms and signs above in the older children, particularly boys between 8 and 15 years of age. Sometimes X-ray testing can be helpful as it can occasionally demonstrate irregularity of the calcaneus bone at the point where the Achilles tendon attaches.
Non Surgical Treatment
* 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: 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: Education on how to self-manage the symptoms and flare-ups of Sever?s disease is an essential part of the treatment.
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.