What is sever’s disease?
Sever’s disease also known as calcaneal apophysitis is the medical term to describe heal pain from repetitive strain or trauma to the growth plate of the calcaneus bone (the heel bone). During adolescence and up until the age of 20 your bones are growing this is made possible by the outer area of bone and in this case the calcaneus growth plate. The Achilles tendon attaches to the growth plate of the heel connecting both the gastrocnemius and soleus muscles (calf muscles) to the foot. The forceful strains repetitively pulling against the growth plate of the calcaneus lead the growth plate to become irritated and inflamed causing it to emit pain and occasionally a bone spur may develop along the site of the tendon insertion.
Why & when does sever’s disease happen?
Sever’s disease is the most common cause of heel pain within young adolescence in particular those who are athletic between the ages of aged 9-13. Normally the condition is developed during rapid growth spurts when the bones are lengthening leaving the surrounding muscles tight and increasing the strain through the Achilles tendon. In other cases it is brought on by sports like football, running, tennis and squash which all cause repetitive and sudden forceful pulls through the tendon. Obesity and poor foot biomechanics like flat feet can also contribute to the condition.
What does sever’s disease feel like?
The symptoms of sever’s disease vary depending on whether the severity of the condition. In most cases the child will experience a strong dull ache and stiffness around the heel area. This stiffness and discomfort may at first only start on activity but will gradually become constant with pain levels increased on aggravating activities like running or jumping. In milder cases the stiffness and discomfort may only occur after activity worsening through the night and early in the morning. In most cases the onset is gradual and the child may have been complaining of pain and stiffness around the heel on and off for weeks or months. They might even be limping ever so slightly with the limp worsening as the pain worsens. The pain doesn’t always stay concentrated around the heel and may refer up into the calf muscles or down into the foot. The heel will be very tender to touch and tight fitted shoes may become uncomfortable and irritating. Occasionally a bone spur will formed along the attachment point of the Achilles tendon you will be able to feel this by rubbing your finger over the back of the heel and feeling for a hard lump.
How long does sever’s disease take to heal?
A mild case of sever’s disease can recover in as little as 8 weeks more moderate or severe cases can take longer however most have fully healed within 6 months normally once the growth spurt has ended. If your child has experienced pain longer than 8 weeks it is advisable to attend your GP. Often the condition will flare with each growth spurt meaning that there is a possibility that your child may be affected over one to two years throughout adolescence.
How will sever’s disease be diagnosed?
Your GP or therapist will be able to diagnose you by both listening to your history and examining you. X-rays may be ordered for further investigation and to confirm diagnosis.
What treatment options are available for sever’s disease?
The symptoms of sever’s disease will gradually ease as your child matures and the growth spurts cease. It is advised that your child maintain activity as long as their symptoms are mild. In more severe cases rest and avoiding aggravating activities until the condition is resolved is advised.
Your GP will most likely prescribe anti-inflammatory medication and painkillers for pain relief and to reduce any swelling. You will be advised to follow the R.I.C.E protocol after activity that aggravates the condition. The R.I.C.E protocol involves Resting your ankle, try not to walk about on it too much and most importantly avoid all aggravating movements. Ice by applying a covered ice pack to the area may also significantly hasten the healing process by reducing the pain and swelling. Please make sure the ice pack is covered to prevent any ice burn and for best results use the icepack use regularly for 10-15 minutes with intervals of 30 minutes. Compression, try and keep the elastic bandage on during the day to limit the swelling and make sure to take it off at night. Elevation, keep your foot raised on cushions or a stool to help limit the swelling.
Your Gp or therapist will be able to provide you with exercises to stretch the gastrocnemius and soleus muscles to aid the healing process and prevent reoccurring injury. Many people find massage therapy helpful to loosen the affected muscles, manipulative therapies such as physiotherapy, chiropractic and osteopathy are thought to help through mobilisation treatment of the ankle working to reduce any stiffness levels and return the joint back to its normal movement.
If your GP has mentioned or if in-fact you feel that there is some element of foot or ankle dysfunction that has predisposed you to this injury then it is very important that you see a podiatrist who can fully examine your feet and determine whether you need orthotics for your shoes or specific running shoes.
To avoid developing sever’s disease make sure that your child stretches before games, avoiding running on hard surfaces too much and wears well fitted shock absorbing shoes.