Sever’s disease (Kids heel pain)

Sever’s Disease is a painful inflammation of the heel’s growth plate which typically affects young children.

The calf comprises of two major muscles – soleus and gastrocnemius which both insert into the heel bone via the Achilles tendon. In the younger athlete (ages 7 - 13 years) skeletal maturity is not reached and growth plate exists where the Achilles tendon inserts to the heel bone.

This growth plate primarily consists of cartilage. During rapid growth, the muscle and tendon becomes tighter and the bone becomes longer.

Forceful, repetitive tension on the growth plate leads to irritation and will result in pain, swelling and sometimes an increased bony prominence on the heel. This condition is called Sever’s lesion or Calcaneal apophysitis.

Studies have shown that Sever’s disease is the second most common osteochondrosis seen in the younger/juvenile athlete.

SIGNS AND SYMPTOMS:

- Pain over the heel area, which increases following an activity that involves strong or repetitive contraction of the calve muscle (running, sprinting, hurdles, jumping, hopping).

- Localised tenderness and swelling at the site of the insertion of the Achilles.

- Tight calf muscles and limited movement in ankle, specifically to pull toe up.

- Bony lump with palpation at the heel

- Limping

CONTRIBUTING FACTORS:

- Inappropriate footwear and training

- Calf tightness and weakness

- Poor foot posture and joint stiffness

- Poor lower limb biomechanics

MANAGEMENT OF SEVER'S DISEASE

This condition will always resolve as the patient moves towards skeletal maturity. It usually takes from 3 - 12 months.

Primarily we aim for activity modification so that the patient is pain-free. Whether the patient should continue to play sport depends on the symptoms and can be clarified by your physiotherapist. It is advised that the patient stays active, provided the symptoms are mild or absent.

Physiotherapy treatment is vital to reduce pain, to allow for increased activity levels and ensure optimal outcomes. It also aids in anti-inflammatory management, as well as soft tissue management.

Treatment includes a full evaluation of biomechanical influences and then correction through flexibility, strength and balance exercises. This will include advice on correct footwear and the use of heel wedges/cups, as suggested in several studies.