Overview
Severs disease is by far the most common cause of heel pain in young children, the condition commonly occurs in kids around the age of 10-15 years. Severs is a traction apophysitis in which inflammation of the calcaneal apophysis (growth plate) occurs as a result of overuse or micro trauma. As mentioned severs disease is caused by micro trauma and over use, this can include excessive foot pronation (foot rolling in), tight calf muscles, increase in sporting activities and inappropriate footwear. These all put extra sheering forces on the growth plate leading to aggravation and resultant pain. Signs and symptoms of this include pain on squeezing of the heel, absence of swelling and redness, child describing pain as a dull ache, limping and pain with increased activity.
Causes
Sever disease, like other similar conditions (eg, Osgood-Schlatter disease, little-leaguer's elbow, and iliac apophysitis), is believed to be caused by decreased resistance to shear stress at the bone-growth plate interface. Studies have indicated that traction apophyses have a higher composition of fibrocartilage than epiphyses subjected more to axial load, which are composed predominantly of hyaline cartilage. The anatomy of the calcaneal apophysis lends to significant shear stress because of its vertical orientation and the direction of pull from the strong gastrocnemius-soleus muscle group.
Symptoms
Adolescents suffering from Sever?s disease usually complain of pain at the back of their heel which is often worse after exercising. It is most common between the ages of 10-12 in boys and 8-10 in girls due to the rapid growth spurts that occur during this time. It can however happen anytime up until the age of 15. Whilst most people present with pain worse in one foot, it is very common to have symptoms in both feet.
Diagnosis
A doctor can usually tell that a child has Sever's disease based on the symptoms reported. To confirm the diagnosis, the doctor will probably examine the heels and ask about the child's activity level and participation in sports. The doctor might also use the squeeze test, squeezing the back part of the heel from both sides at the same time to see if doing so causes pain. The doctor might also ask the child to stand on tiptoes to see if that position causes pain. Although imaging tests such as X-rays generally are not that helpful in diagnosing Sever's disease, some doctors order them to rule out other problems, such as fractures. Sever's disease cannot be seen on an X-ray.
Non Surgical Treatment
In general, the goals for treatment include reducing the localized areas of inflammation. We recommend that patients utilize Ibuprofen every six to eight hours as needed. Stretching exercises on a daily basis, as well as prior to activity is thought to be helpful as well. Following work-outs and increased activities, it may be helpful to apply ice over affected areas. Heel cups are also available to provide cushion in shoes. In addition, for more severe symptoms, it may be helpful to refrain from sports and/or immobilize the area for a few weeks to help reduce the inflammation.
Severs disease is by far the most common cause of heel pain in young children, the condition commonly occurs in kids around the age of 10-15 years. Severs is a traction apophysitis in which inflammation of the calcaneal apophysis (growth plate) occurs as a result of overuse or micro trauma. As mentioned severs disease is caused by micro trauma and over use, this can include excessive foot pronation (foot rolling in), tight calf muscles, increase in sporting activities and inappropriate footwear. These all put extra sheering forces on the growth plate leading to aggravation and resultant pain. Signs and symptoms of this include pain on squeezing of the heel, absence of swelling and redness, child describing pain as a dull ache, limping and pain with increased activity.
Causes
Sever disease, like other similar conditions (eg, Osgood-Schlatter disease, little-leaguer's elbow, and iliac apophysitis), is believed to be caused by decreased resistance to shear stress at the bone-growth plate interface. Studies have indicated that traction apophyses have a higher composition of fibrocartilage than epiphyses subjected more to axial load, which are composed predominantly of hyaline cartilage. The anatomy of the calcaneal apophysis lends to significant shear stress because of its vertical orientation and the direction of pull from the strong gastrocnemius-soleus muscle group.
Symptoms
Adolescents suffering from Sever?s disease usually complain of pain at the back of their heel which is often worse after exercising. It is most common between the ages of 10-12 in boys and 8-10 in girls due to the rapid growth spurts that occur during this time. It can however happen anytime up until the age of 15. Whilst most people present with pain worse in one foot, it is very common to have symptoms in both feet.
Diagnosis
A doctor can usually tell that a child has Sever's disease based on the symptoms reported. To confirm the diagnosis, the doctor will probably examine the heels and ask about the child's activity level and participation in sports. The doctor might also use the squeeze test, squeezing the back part of the heel from both sides at the same time to see if doing so causes pain. The doctor might also ask the child to stand on tiptoes to see if that position causes pain. Although imaging tests such as X-rays generally are not that helpful in diagnosing Sever's disease, some doctors order them to rule out other problems, such as fractures. Sever's disease cannot be seen on an X-ray.
Non Surgical Treatment
In general, the goals for treatment include reducing the localized areas of inflammation. We recommend that patients utilize Ibuprofen every six to eight hours as needed. Stretching exercises on a daily basis, as well as prior to activity is thought to be helpful as well. Following work-outs and increased activities, it may be helpful to apply ice over affected areas. Heel cups are also available to provide cushion in shoes. In addition, for more severe symptoms, it may be helpful to refrain from sports and/or immobilize the area for a few weeks to help reduce the inflammation.