Overview
Severs Disease is a common cause of heel pain in children. It is seen most commonly in children aged 5 - 11 years old. Children with Severs Disease will complain of heel pain that increases with activity. The pain is often relieved by rest, although some children will continue to have pain with regular activities, such as walking. Severs Disease has much in common with Osgood-Schlatter Disease. Both are described as being a traction apophysitis.
Causes
Overuse and stress on the heel bone through participation in sports is a major cause of calcaneal apophysitis. 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 of calcaneal apophysitis include obesity, a tight Achilles tendon, and biomechanical problems such as flatfoot or a high-arched foot.
Symptoms
The most obvious sign of Sever's disease is pain or tenderness in one or both heels, usually at the back. The pain also might extend to the sides and bottom of the heel, ending near the arch of the foot. A child also may have these related problems, swelling and redness in the heel, difficulty walking, discomfort or stiffness in the feet upon awaking, discomfort when the heel is squeezed on both sides, an unusual walk, such as walking with a limp or on tiptoes to avoid putting pressure on the heel. Symptoms are usually worse during or after activity and get better with rest.
Diagnosis
Sever?s disease can be diagnosed based on your history and symptoms. Clinically, your physiotherapist will perform a "squeeze test" and some other tests to confirm the diagnosis. Some children suffer Sever?s disease even though they do less exercise than other. This indicates that it is not just training volume that is at play. Foot and leg biomechanics are a predisposing factor. The main factors thought to predispose a child to Sever?s disease include decrease ankle dorsiflexion, abnormal hind foot motion eg overpronation or supination, tight calf muscles, excessive weight-bearing activities eg running.
Non Surgical Treatment
Depending on the Podiatrist's diagnosis and the severity of the pain, there are several treatment options available. Rest/ reduced activity: your child should reduce or stop any activity that causes pain, such as sports and running. This can be a difficult option, as children are normally quite willful in pursuit of their favorite pastimes! Over the counter anti-inflammatory drugs, such as ibuprofen (found in Nurofen), to help reduce pain and inflammation. Try to make sure your child does the recommended stretching exercises before sport/play. This will should help reduce the stress on the fascia tendon and relieve heel pain. The use of Orthotic insoles. Footactive Kids orthotics are made for children. They will help properly support the foot, help prevent over-pronation or improper gait restoring your child's foot the the correct biomechanical position. If you are in any doubt or your child's foot pain persists then please arrange an appointment with a Podiatrist or Physiotherapist. Please click here for more information on the use of orthotics for children.
Prevention
It is important to undertake correct warm ups and warm downs before and after exercise. This should include a stretching routine. It may be necessary to undertake additional stretching outside of sport, especially during stages of growth. Only playing one sport should be avoided. You should not allow your child to play through pain.
Severs Disease is a common cause of heel pain in children. It is seen most commonly in children aged 5 - 11 years old. Children with Severs Disease will complain of heel pain that increases with activity. The pain is often relieved by rest, although some children will continue to have pain with regular activities, such as walking. Severs Disease has much in common with Osgood-Schlatter Disease. Both are described as being a traction apophysitis.
Causes
Overuse and stress on the heel bone through participation in sports is a major cause of calcaneal apophysitis. 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 of calcaneal apophysitis include obesity, a tight Achilles tendon, and biomechanical problems such as flatfoot or a high-arched foot.
Symptoms
The most obvious sign of Sever's disease is pain or tenderness in one or both heels, usually at the back. The pain also might extend to the sides and bottom of the heel, ending near the arch of the foot. A child also may have these related problems, swelling and redness in the heel, difficulty walking, discomfort or stiffness in the feet upon awaking, discomfort when the heel is squeezed on both sides, an unusual walk, such as walking with a limp or on tiptoes to avoid putting pressure on the heel. Symptoms are usually worse during or after activity and get better with rest.
Diagnosis
Sever?s disease can be diagnosed based on your history and symptoms. Clinically, your physiotherapist will perform a "squeeze test" and some other tests to confirm the diagnosis. Some children suffer Sever?s disease even though they do less exercise than other. This indicates that it is not just training volume that is at play. Foot and leg biomechanics are a predisposing factor. The main factors thought to predispose a child to Sever?s disease include decrease ankle dorsiflexion, abnormal hind foot motion eg overpronation or supination, tight calf muscles, excessive weight-bearing activities eg running.
Non Surgical Treatment
Depending on the Podiatrist's diagnosis and the severity of the pain, there are several treatment options available. Rest/ reduced activity: your child should reduce or stop any activity that causes pain, such as sports and running. This can be a difficult option, as children are normally quite willful in pursuit of their favorite pastimes! Over the counter anti-inflammatory drugs, such as ibuprofen (found in Nurofen), to help reduce pain and inflammation. Try to make sure your child does the recommended stretching exercises before sport/play. This will should help reduce the stress on the fascia tendon and relieve heel pain. The use of Orthotic insoles. Footactive Kids orthotics are made for children. They will help properly support the foot, help prevent over-pronation or improper gait restoring your child's foot the the correct biomechanical position. If you are in any doubt or your child's foot pain persists then please arrange an appointment with a Podiatrist or Physiotherapist. Please click here for more information on the use of orthotics for children.
Prevention
It is important to undertake correct warm ups and warm downs before and after exercise. This should include a stretching routine. It may be necessary to undertake additional stretching outside of sport, especially during stages of growth. Only playing one sport should be avoided. You should not allow your child to play through pain.