Overview
Sever's disease is an injury to a child's still developing foot structure, specifically an inflammation in the heel's growth plate due to muscle strain and repetitive stress. It is common in young athletes and children who have problems with pronation. Sever's Disease usually occurs in children age 8, 14 years of age when the child's bones are still in the growth stage and the growth plates have not become ossified.
Causes
There are several causes of heel pain in the young athletic population with the most common being calcaneal apophysitis (also referred to as Sever?s disease). Sever first reported calcaneal apophysitis in 1912 as an inflammation of the apophysis, causing discomfort to the heel, mild swelling and difficulty walking in growing children. The condition usually manifests between the ages of 8 and 14 with a higher incidence in boys than girls. In reality, however, calcaneal apophysitis is being diagnosed more frequently in girls due to their increase in participating in sports such as soccer, basketball and softball.
Symptoms
On examination, the typical signs are tenderness on palpation of the heel, particularly on deep palpation at the Achilles tendon insertion. Pain on dorsiflexion of the ankle, particularly when doing active toe raises; forced dorsiflexion of the ankle is also uncomfortable. Swelling of the heel, usually mild. Calcaneal enlargement, in long-standing cases.
Diagnosis
To diagnose the cause of the child?s heel pain and rule out other more serious conditions, the foot and ankle surgeon obtains a thorough medical history and asks questions about recent activities. The surgeon will also examine the child?s foot and leg. X-rays are often used to evaluate the condition. Other advanced imaging studies and laboratory tests may also be ordered.
Non Surgical Treatment
Initially, Sever?s Disease is treated with rest, anti-inflammatory medication and softer shoes. Ice followed by heat is a common practice and heel cup orthotics have worked wonders for our young patients in the past. It can take anywhere from a few weeks to a year for these growth plates to naturally close - at which point Sever?s Disease disappears. Even though the condition does heal on its own, athletes are encouraged to seek treatment, rather than push through the pain. Simply ?dealing with it? and continuing to play sports despite the injury could lead to an impaired gait, a strained hip or a knee injury. Stretches to strengthen the leg muscles, leg compression wraps and over-the-counter acetaminophen or ibuprofen are also recommended treatments. In very rare cases, a podiatrist may recommend wearing a cast for two to twelve weeks.
Surgical Treatment
The surgeon may select one or more of the following options to treat calcaneal apophysitis. Reduce activity. The child needs to reduce or stop any activity that causes pain. Support the heel. Temporary shoe inserts or custom orthotic devices may provide support for the heel. Medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, help reduce the pain and inflammation. Physical therapy. Stretching or physical therapy modalities are sometimes used to promote healing of the inflamed issue. Immobilization. In some severe cases of pediatric heel pain, a cast may be used to promote healing while keeping the foot and ankle totally immobile. Often heel pain in children returns after it has been treated because the heel bone is still growing. Recurrence of heel pain may be a sign of calcaneal apophysitis, or it may indicate a different problem. If your child has a repeat bout of heel pain, be sure to make an appointment with your foot and ankle surgeon.
Sever's disease is an injury to a child's still developing foot structure, specifically an inflammation in the heel's growth plate due to muscle strain and repetitive stress. It is common in young athletes and children who have problems with pronation. Sever's Disease usually occurs in children age 8, 14 years of age when the child's bones are still in the growth stage and the growth plates have not become ossified.
Causes
There are several causes of heel pain in the young athletic population with the most common being calcaneal apophysitis (also referred to as Sever?s disease). Sever first reported calcaneal apophysitis in 1912 as an inflammation of the apophysis, causing discomfort to the heel, mild swelling and difficulty walking in growing children. The condition usually manifests between the ages of 8 and 14 with a higher incidence in boys than girls. In reality, however, calcaneal apophysitis is being diagnosed more frequently in girls due to their increase in participating in sports such as soccer, basketball and softball.
Symptoms
On examination, the typical signs are tenderness on palpation of the heel, particularly on deep palpation at the Achilles tendon insertion. Pain on dorsiflexion of the ankle, particularly when doing active toe raises; forced dorsiflexion of the ankle is also uncomfortable. Swelling of the heel, usually mild. Calcaneal enlargement, in long-standing cases.
Diagnosis
To diagnose the cause of the child?s heel pain and rule out other more serious conditions, the foot and ankle surgeon obtains a thorough medical history and asks questions about recent activities. The surgeon will also examine the child?s foot and leg. X-rays are often used to evaluate the condition. Other advanced imaging studies and laboratory tests may also be ordered.
Non Surgical Treatment
Initially, Sever?s Disease is treated with rest, anti-inflammatory medication and softer shoes. Ice followed by heat is a common practice and heel cup orthotics have worked wonders for our young patients in the past. It can take anywhere from a few weeks to a year for these growth plates to naturally close - at which point Sever?s Disease disappears. Even though the condition does heal on its own, athletes are encouraged to seek treatment, rather than push through the pain. Simply ?dealing with it? and continuing to play sports despite the injury could lead to an impaired gait, a strained hip or a knee injury. Stretches to strengthen the leg muscles, leg compression wraps and over-the-counter acetaminophen or ibuprofen are also recommended treatments. In very rare cases, a podiatrist may recommend wearing a cast for two to twelve weeks.
Surgical Treatment
The surgeon may select one or more of the following options to treat calcaneal apophysitis. Reduce activity. The child needs to reduce or stop any activity that causes pain. Support the heel. Temporary shoe inserts or custom orthotic devices may provide support for the heel. Medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, help reduce the pain and inflammation. Physical therapy. Stretching or physical therapy modalities are sometimes used to promote healing of the inflamed issue. Immobilization. In some severe cases of pediatric heel pain, a cast may be used to promote healing while keeping the foot and ankle totally immobile. Often heel pain in children returns after it has been treated because the heel bone is still growing. Recurrence of heel pain may be a sign of calcaneal apophysitis, or it may indicate a different problem. If your child has a repeat bout of heel pain, be sure to make an appointment with your foot and ankle surgeon.