Overview
Sever?s disease is repetitive micro trauma or overuse of the heel in young athletes. Sever?s is caused by overloading the insertion of the Achilles tendon onto the calcaneus and the apophyseal growth plate. Active Children (7 to 15 years), particularly during the pubertal growth spurt or at the beginning of a sport season (e.g. gymnasts, basketball and football players), often suffer from this condition.
Causes
The most common of the Sever?s disease causes is when the heel bone grows more rapidly than the muscles and tendons in the leg. The muscles and tendons become tight and put additional stress on the growth plate in the heel. When this happens, the growth plate begins to swell, becomes tender, and the child will essentially begin to feel one or more Sever?s disease symptoms. It can occur in any child as they grow, but there are some common Sever?s disease causes and risk factors that make a child more prone to the condition. They include participation in sports and other activities that put pressure on the heel, such as basketball, track, and gymnastics. A pronated foot, which makes the Achilles tendon tight, increasing the strain on the growth plate of the heel. An arch that is flat or high, affecting the angle of the heel. Short leg syndrome, when one leg is shorter than the other, causing the shorter leg to pull more on the Achilles tendon in order to reach the ground. Obesity puts extra weight on the growth plate, which can cause it to swell.
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
Physical examination varies depending on the severity and length of involvement. Bilateral involvement is present in approximately 60% of cases. Most patients experience pain with deep palpation at the Achilles insertion and pain when performing active toe raises. Forced dorsiflexion of the ankle also proves uncomfortable and is relieved with passive equinus positioning. Swelling may be present but usually is mild. In long-standing cases, the child may have calcaneal enlargement.
Non Surgical Treatment
Traditional treatment involved simply telling children that they can?t play sport for a year. This is not popular for children or parents and abstaining from sport leads to other problems when wanting to return. Treatments focus on improving foot and lower limb function with footwear selection, heel raises, calf stretching, prescription orthoses, run technique training and training modifications. This results in a reduced load through the growth plate and the child can perform more activity before the growth plate becomes inflamed. Rest will always reduce the Sever?s disease symptoms, however this is always the last option.
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.
Sever?s disease is repetitive micro trauma or overuse of the heel in young athletes. Sever?s is caused by overloading the insertion of the Achilles tendon onto the calcaneus and the apophyseal growth plate. Active Children (7 to 15 years), particularly during the pubertal growth spurt or at the beginning of a sport season (e.g. gymnasts, basketball and football players), often suffer from this condition.
Causes
The most common of the Sever?s disease causes is when the heel bone grows more rapidly than the muscles and tendons in the leg. The muscles and tendons become tight and put additional stress on the growth plate in the heel. When this happens, the growth plate begins to swell, becomes tender, and the child will essentially begin to feel one or more Sever?s disease symptoms. It can occur in any child as they grow, but there are some common Sever?s disease causes and risk factors that make a child more prone to the condition. They include participation in sports and other activities that put pressure on the heel, such as basketball, track, and gymnastics. A pronated foot, which makes the Achilles tendon tight, increasing the strain on the growth plate of the heel. An arch that is flat or high, affecting the angle of the heel. Short leg syndrome, when one leg is shorter than the other, causing the shorter leg to pull more on the Achilles tendon in order to reach the ground. Obesity puts extra weight on the growth plate, which can cause it to swell.
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
Physical examination varies depending on the severity and length of involvement. Bilateral involvement is present in approximately 60% of cases. Most patients experience pain with deep palpation at the Achilles insertion and pain when performing active toe raises. Forced dorsiflexion of the ankle also proves uncomfortable and is relieved with passive equinus positioning. Swelling may be present but usually is mild. In long-standing cases, the child may have calcaneal enlargement.
Non Surgical Treatment
Traditional treatment involved simply telling children that they can?t play sport for a year. This is not popular for children or parents and abstaining from sport leads to other problems when wanting to return. Treatments focus on improving foot and lower limb function with footwear selection, heel raises, calf stretching, prescription orthoses, run technique training and training modifications. This results in a reduced load through the growth plate and the child can perform more activity before the growth plate becomes inflamed. Rest will always reduce the Sever?s disease symptoms, however this is always the last option.
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.