Do you notice your child limping? Do they complain about heel pain during or after exercise? Do they have to leave the pitch because of this pain? It may be Sever’s disease, also known as calcaneal apophysitis. Here we discuss all about this condition, how to manage it and how to prevent your child from being sidelined.
What Is Sever’s Disease?
It is an injury, rather than a disease, which is why it is now referred to as calcaneal apophysitis. We will call it Sever’s for the purpose of this blog as it’s still commonly called this. It is an inflammation of the growth plate in the heel. A growth plate is a layer of cartilage located near the end of a bone, where most of the bone growth occurs in children and teenagers. The growth plate is weaker than the rest of the bone and therefore more prone to injury.
Sever’s develops when the calf muscles and Achilles tendon become tight and pull on the heel’s growth plate, resulting in pain, tenderness and inflammation at the back of the heel. High impact activities, such as running, can irritate this area and worsen the condition. Children who are overweight and who wear poorly constructed footwear are more at risk.
How Exercise Affects It
As summer approaches, children are getting back into the swing of sports and exercise. Be that football, hurling or dancing to name a few. It’s a competitive yet enjoyable time of year, but the increased amount of activity, particularly when children play a variety of sports throughout the week, can lead to injuries.
Unfortunately Sever’s is one of the most common heel pain conditions in those aged between 8-13 and it is more common in boys than girls. Children and teenagers experience growth spurts, which when combined with too much exercise can lead to Sever’s. During a growth spurt, the muscles, tendons and bones grow at different rates. Therefore, it can also occur among those who are less active, although sports increase the likelihood of occurrence.
How Is It Treated?
Most cases should resolve with rest. If your child has a severe case of Sever’s, a rest period of up to 8 weeks may be recommended, which means no stress or activity that can cause a flare up, even running in your garden at home.
Regular application of ice for 15 minutes can reduce pain and inflammation. Over the counter medication may be advised by a healthcare professional. Other measures like a change in footwear as well as a calf and Achilles tendon stretching and strengthening exercise programme are very successful at alleviating pain. Once the activity does not cause pain, the child can usually return to their normal activities.
Footwear Advice
Check your child’s shoes for worn interiors at the back of the heel, which can cause irritation. Footwear should be a good fit - it is a good idea to stand on the footbed (insole/inner) of a shoe, if easily removable, to ensure there is at least a thumbnail between the toes and the end of the footbed.
Laced shoes are best, if possible, as they can be loosened or tightened as needed. Slip-on shoes or shoes that are too big can cause irritation to the back of the heel. Strong, well constructed footwear with thicker, shock absorbing soles and cushioned interior to the heel area can offer more comfort and reduce pressure.
Professional Treatment
At your appointment, a podiatrist will do the following:
Take a detailed history and rule out other conditions.
Assess your child’s footwear, to ensure they have enough support and are appropriate for their activity. It is advised to bring their sports footwear to the appointment for this reason.
Perform a squeeze test to diagnose the condition, by squeezing each side of the heel.
Advise on a timeframe for rest according to the severity.
Demonstrate and explain an exercise programme with your child, to ensure they have the correct method. A handout or email with the exercises on them is helpful to take home from the appointment to ensure they are carried out as directed.
Gel heel pads may be suggested to provide short term relief. These should be placed in each shoe to avoid a leg length difference.
Insoles may also be advised depending on the child’s foot posture or alignment and can provide support as well as pain relief.
An X-ray may be recommended if the pain is too sharp and severe, to rule out a fracture.
Will It Happen Again?
The heel pain may reoccur after the symptoms resolve as the heel growth plate continues to grow until around the age of 14, when it changes to bone. Once this happens, they will have outgrown this condition and it will not develop again.
References
- Engadinephysiopilates.com.au. 2020. Sever’S Disease | Cause, Symptoms, Treatment & Taping. [online image] Available at: <https: data-preserve-html-node="true"//www.engadinephysiopilates.com.au/blog/severs-disease> [Accessed 8 April 2020].
- Orthoinfo.aaos.org. 2020. Sever's Disease (Heel Pain) - Orthoinfo - AAOS. [online] Available at: <https: data-preserve-html-node="true"//orthoinfo.aaos.org/en/diseases--conditions/severs-disease/> [Accessed 7 April 2020].
- Peak Podiatry. 2018. Sever's Disease - Peak Podiatry. [online image] Available at: <https: data-preserve-html-node="true"//peakpodiatry.com.au/2018/02/09/severs-disease/#iLightbox%5Bgallery3121%5D/0> [Accessed 8 April 2020].
- Su MD, A., 2019. Sever's Disease (For Parents) - Nemours Kidshealth. [online] Kidshealth.org. Available at: <https: data-preserve-html-node="true"//kidshealth.org/en/parents/severs-disease.html> [Accessed 7 April 2020].