Addressing Severs Disease

Overview

It is thought to be a traction injury, where the Achilles tendon and Plantar fascia pull in opposite directions. Sever?s occurs in children aged 8 to 16 years old. In children, the heel bone is made up of 2 bones, with a growth plate of cartilage in between the sections, holding these 2 bones together. As the cartilage expands, the edges of it eventually turn to bone, and finally the gap closes. This usually occurs within the first 13-15 years of life. However, because these bones are connected by cartilage they are weaker than normal bones. This is why they are very vulnerable to injury.

Causes

The condition generally occurs in active children at early adolescence during rapid growth periods as the heel bone can grow faster than the leg muscles causing them to become tight and overstretched. Sever?s disease most often caused by inadequate footwear, playing sport on hard surfaces, calf tightness and biomechanical problems.

Symptoms

Unilateral or bilateral heel pain. Heel pain during physical exercise, especially activities that require running or jumping. Increased pain level after exercise. A tender swelling or bulge on the heel that is painful on touch. Limping. Calf muscle stiffness first thing in the morning.

Diagnosis

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

When the condition flares, it is treated with activity limitation, medication to reduce inflammation (such as ibuprofen [Advil] or naproxen [Aleve]), shoe inserts, heel lifts, cold packs, and sometimes casting when it becomes especially severe. Sever condition is generally a self-limited problem that usually improves within a year.

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.

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