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Sever’s Disease…What is it?

Firstly it is referred to as Sever’s Disease or Calcaneal Apophysitis. While I don’t see it that often, it is something that exists. To be honest, I’d probably see more of it, if parents were more in sync with having their children see a podiatrist. Or, if they just listen to their complaints all the same.

It occurs in children typically between the ages of 8 to 14, in some instances 15. It’s when the growth plate, (the growing part of the heel), is injured. The foot is one of the first body parts to grow to full size. This usually happens 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, (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.

Causes

Overuse and stress on the heel bone through participation in sports, are a major cause of Sever’s. The heel’s growth plate is sensitive to repeated running and pounding on hard surfaces, resulting in muscle strain and inflamed tissue. For this reason, children and adolescents involved in soccer, track, or basketball, are especially vulnerable. Other potential causes include: obesity, a tight Achilles tendon, and biomechanical problems, such as flatfoot or a high-arched foot.

Symptoms

Symptoms may include:

  • Pain in the back or bottom of the heel
  • Limping
  • Walking on toes
  • Difficulty running, jumping or participating in usual activities or sports
  • Pain when the sides of the heel are squeezed
  • Tiredness
When is your child most at risk for Sever’s disease?

Your child is most at risk for this condition when he or she is in the early part of the growth spurt in early puberty. It is most common in physically active girls 8 – 10 years old,  and in physically active boys 10 – 12 years of age. Soccer players and gymnasts often get Sever’s disease, but children who do any running or jumping activity may also be at an increased risk. The disease rarely occurs in older teenagers, because the back of the heel has typically finished growing by age 15.

Diagnosis

In Sever’s disease, heel pain can be in one or both heels. It usually starts after a child begins a new sports season or a new sport. Your child may walk with a limp. The pain may increase when he or she runs or jumps. He or she may have a tendency to tiptoe. Your child’s heel may hurt if you squeeze both sides toward the very back. This is called the squeeze test. Your doctor/ podiatrist may also find that your child’s heel tendons have become tight.

Prevention

The disease may be prevented by maintaining good flexibility while your child is growing. Stretching exercises can lower your child’s risk for injuries during the growth spurt. Good quality shoes with firm support and a shock-absorbent sole will help. Your child should avoid excessive running on hard surfaces. If your child has already recovered from Sever’s disease, stretching, and putting ice on the heel after activity, will help to keep  the condition from recurring.

Treatment

First, your child should cut down or stop any activity that causes heel pain. Apply ice to the injured heel for 20 minutes, 3 times a day. If the child has a high arch, flat feet or bowed legs, your doctor may recommend orthotics, or heel cups. The child should never go barefoot.

Will stretching exercises help?

Yes, stretching exercises can help. It is important that exercises be performed  to stretch the hamstring and calf muscles, along with the tendons on the back of the leg. These stretches should be done 2 or 3 times a day. Each stretch should be held for about 20 seconds. Both legs should be stretched, even if the pain is only in 1 heel.

When can my child play sports again?

With proper care, your child should feel better within 2 weeks to 2 months. Your child can start playing sports again only when the heel pain is gone. Your doctor/ podiatrist will let you know when physical activity is safe.

Your feet mirror your general health . . . cherish them!

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