Calcaneal apophysitis, or Sever’s disease, is a common ailment among young, active, growing children and teens. This inflammation of the growth plate in the heel is associated with a combination of intense activity and intense growth. In this article, we discuss Sever’s disease and provide good advice to help you get your child through this painful, but non-life threatening, experience. Read on to learn more.
Why Does Sever’s Disease Happen?
Children and adolescents have growth plates (areas of cartilage) at the ends of bones. These plates provide flexibility for growing. When a teen finishes growing, the plates close and transform into solid bone. Until this happens, these areas represent points of weakness and are susceptible to trauma.
The growth plate at the back of the heel is affected by Sever’s disease. This area is also the Achilles tendon’s attachment point. The Achilles tendon is a strong tissue band connecting the heel bone to the calf muscles that run along the back side of the lower leg.
How Does Sever’s Disease Develop?
Sever’s disease is a repetitive motion or overuse injury. Repeated motions, such as those experienced during organized sport, and excessive weight bearing (standing, walking, running, jumping) combine to create inflammation in the heel and surrounding tendons, ligaments and muscles.
Who is Most Susceptible to Developing Sever’s Disease?
Boys between the ages of five and thirteen who participate in sports are most likely to develop this condition. In fact, a full sixty percent of Sever’s patients belong to this demographic.
Any child or adolescent could develop Sever’s, though. Children who are undergoing a growth spurt are susceptible. Additionally, children who do not wear good quality, supportive shoes tend to develop this problem.
What Do the Symptoms Look Like?
Children and teens experiencing Sever’s disease often complain of back-of-heel pain which worsens when walking, running, jumping and participating in sports (especially basketball, baseball and soccer). Pain and swelling may be present in one or both heels, and this may cause your child to limp.
How Do You Treat Sever’s Disease?
Because it is an inflammatory condition, reduction of pain and swelling are the main focal points of treatment. Your child may have to refrain from athletics and other high impact activities for a period of months. Physical therapy to build strength in the heels may be required. Doctor’s recommendations for treatment of this condition typically include:
1. Modify activity: Greatly reduce or eliminate participation in sports until all symptoms have resolved.
2. Stretch: Perform Achilles tendon and calf stretches on a regular basis to strengthen the heels and calves and reduce pain.
3. Use orthotics: Adding heel cups to good quality footwear can provide more support and cushioning for painful, delicate heels.
4. Elevate the heel: Don’t wear flat shoes. All footwear should have a slight heel to help relieve growth plate pressure.
5. NSAIDS: Take over-the-counter pain relievers and anti-inflammatory medications such as naproxin or ibuprofen to reduce pain and inflammation.
6. Cool your heels: While resting your feet, apply cold packs to reduce inflammation and relieve pain.
What if Light Treatment Doesn’t Help?
In stubborn cases, your doctor may prescribe a “walker boot” to keep the foot immobilized until it heals. In very severe cases, a short-leg cast may be needed to force rest.
How Long Will it Take to Heal?
Complete recovery usually takes two or three months; however, it can take longer, and the condition can return over a period of several years. Luckily, there are no long-term complications associated with this condition. Once the symptoms have been completely resolved and the child’s growth is complete, the condition should not return.
How Does a Doctor Diagnose Sever’s Disease?
When you take your child to the doctor about this problem, the physician will perform a general exam and ask questions about your child’s health and symptoms. The doctor will examine your child’s feet and ankles thoroughly and will apply pressure to the sides and bottoms of the feet to judge the amount of pain present.
The doctor may request that your child move around, walk, run and jump in order to see how the pain affects your child’s gait. Your child’s doctor may want to have an x-ray taken in order to rule out causes such as infection, tumors and fractures.
What is the Typical Outcome of Sever’s Disease?
While your child is growing, this condition may reoccur many times. The best way to cope with this is to closely monitor activities and adjust as needed to accommodate pain.
Be sure your child always has the right kind of footwear for sports activities and everyday use.
Teach your child to practice RICE (rest, ice, compression and elevation) as a standard part of recovery after sports practice and games.
When your child has finished growing and the heel’s growth plate has transformed into bone, the disease will not return.