Severs disease is a nasty name for a less nasty but incredibly common problem affecting boys and girls from the ages to 8-14.
Sever’s (named after Mr Sever) is more accurately called Calcaneal Apophysitis. It is a painful inflammation of the heel’s growth plate. The heel bone (calcaneus) is not fully developed until we are at least 14 years old. Until then, new bone is forming and whilst the new bone is forming, the muscles (and tendons) are desperately trying to catch up.
This catching up and the repeated stress of the Achilles tendon pulling on the back of the heel at this point which is at this time weak because of the growth plate causes inflammation and pain.
How common is it?
It would be unusual to put a group of 20 kids together around these ages and not find that at least a few of them have had this type of pain. Prevalence in studies range from 10-20%.
Like any injury, the pain can range greatly. Kids may not even pick up on the pain, it is often a parent or guardian who notices a child limping on the foot, favouring the other leg or grabbing at and reaching for the heel during or after an activity. Other symptoms to watch out for include..
Walking on the toes
Difficulty running or jumping
Pain when the sides of the heel are squeezed
A skipping style of running or accelerating
Pain after activity and after rest following activity
Irritability with sports or movement
Why do some kids experience pain and not others?
Good question. There are lots of factors that can contribute to developing the condition. Often it is this, a combination, rather than 1 specific reason. Some of the factors that I will often question and look out for include…
A recent increase in activity (i.e taken up a new sport, more training e.g started football training at the same time as basketball training, started walking the dog more, got a new trampoline for xmas etc etc.)
Reduced ankle range of motion - A reduced ankle range of motion can leave certain kids more prone to developing severs. An already tight calf muscle can mean after a growth spurt can tip it over the edge. It also means that their biomechanics are more likely to develop compensations that might not be optimal.
Recent growth spurts - If you notice a recent growth spurt it means other growth plates have recently been active too. If they have been, the heel bones like to have been active as well.
Strange biomechanics. This can be lots of things and can increase the likelihood for several reasons. Some things I will look out for are flat feet, high arches or most often - asymmetries between the right and left side.
Weak muscles. Weak might not be fair, but if your child is having trouble getting up and down from their tippy toes easily, they will be more likely to develop issues if their load (see above) suddenly increases.
Great. How do we get rid of it?
Like many of life’s ailments, severs is cured by time. The growth plates that cause the injury will heal (barring rare cases). The real question is what do you do in the meantime? We can’t be having our kids limping and in pain for years on end until it eventually resolves.
There are plenty of really great and really simple treatments that can help accelerate the healing process and decrease the pain. These include….
Load management. Sometimes this can be as simple as sitting out p.e class for a few weeks or skipping football training one night a week. Honestly, by the time these patients generally come to see me, they are beyond this. Most parents and guardians will try this to start with and when it doesn’t work they will consult Dr Google or hopefully see a Podiatrist who specialises in biomechanics (like ours at Wagga Podiatry Plus). A good assessment will involve a deep dive into what your kid is doing, when, for how long and at what intensity. This way we can pinpoint what elements might be the straw that's broken the camels back and rectify it - reducing pain and getting them back on their feet asap.
Offload, Offload, Offload. - Inflamed and injured areas like rest. How the area is offloaded depends on the individual biomechanics but some common ways include foot orthoses (orthotics), heel raises, arch supports or internal shoe padding. When done properly, these can be incredibly effective tools to reduce the load through the injured area without having to reduce what your child is doing.
Strengthen - Severs can respond really well to gentle loading exercises. Strengthening and mobilising the calf muscles and intrinsic muscles of the foot can take some pressure off of the injured area and increase its tolerance to the load of which is being asked of it.
Ice. Ice can be a bit hit and miss but it can improve the pain associated with the condition. Try applying ice to the area for 15 minutes after the activity. If it seems to help, keep doing it for a week.
So what now?
One of the most important things that you can do is get on top of any pain or injury early. If you notice your kids complaining of pain or see them grabbing at their leg it is best to put in to place some of those measures right away. The most effective initial play is modifying their activity. Skipping football training for a couple of weeks or only doing 1 dance class a week instead of two might just be enough to nip the problem in the bud before it becomes a real problem.
If this doesn’t happen the next move is to have them assessed by a Podiatrist or Physio. Wagga Podiatry Plus podiatrists are extensively trained and skilled at treating growing pain injuries like severs disease.
If you have any questions or would like to book an online or face-to-face assessment please contact us via our website www.waggapodiatryplus.com.au
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