Severs - Heel Pain In Kids
What is Severs?
You’ve probably heard the phrase “growing pains” at some point in your life. You might have thought that it was nothing more than an old wives’ tale, but in reality, growth can actually result in some painful conditions. Calcaneal apophysitis or Sever’s disease is a great example of this.
Children and teenagers’ bones have an area called “growth plate”. Every bone has its own growth plate. These areas are formed by cartilage and they allow the bones to grow and stretch over time. Once a child is done growing, the growth plates are replaced by solid bone; but until this happens, growth plates are softer and more injury-prone than other parts of the bone.
The calcaneus bone, also known as the heel bone, also has its own growth plate. In most children, this growth plate won’t be fully developed until they’re approximately 14 years old. The growth plate or physis in the calcaneus is located near the bottom of the heel. Sever’s disease occurs when this area suffer from repetitive stress, which causes inflammation and pain. Sever’s disease isn’t truly a disease; however, it’s the most common cause of heel pain in children and teenagers. It can affect one or both feet.
It’s no secret that children and teenagers tend to be very active. Repetitive activities such as jumping, running, and playing sports can place pressure on the heel bone. Additionally, growing tissues tend to develop at different rates. That means that muscles and tendons can be overstretched and become tight, pulling on the calcaneus growth plate. The growth plate is also the place where the Achilles’ tendon attaches itself. Pulling on the Achilles’ tendon causes extra friction and irritation, worsening this condition.
- Pain under the heel
- Swelling and redness in the heel
- Pain when the heel is squeezed
- Pain that worsens with activity and improves with rest
- Stiff feet upon waking up
- Limping, or walking on tiptoes
- Difficulty participating in physical activities
The pain caused by Sever’s disease is localised on the posterior and plantar areas of the foot, right above the calcaneal apophysis. Sever’s disease is more likely to appear in children or teenagers during a growth spur (between ages 8 to 14) and those who participate in sports or other physical activities. Sever’s disease is particularly common in children who participate in sports that are performed on hard surfaces, such as basketball or gymnastics. However, any child can develop this condition.
How is Sever’s disease diagnosed?
A podiatrist or physiotherapist can diagnose this condition based on the child’s symptoms and history. There are several factors that can predispose a child to Sever’s disease; these factors include:
- Tight calf muscles
- Overpronation or supination of the hind foot
- Excessive physical activity
- Decreased ankle dorsiflexion
If you notice that your child has symptoms compatible with Sever’s disease and take them to the doctor or podiatrist, a simple physical examination will usually be enough to diagnose this condition. Although Sever’s disease can’t be diagnosed through an X ray, additional test might be ordered to rule out other causes of heel pain in some cases.
How is Sever’s disease treated?
The treatment for this condition is focused on relieving pain and swelling. One of the first steps in treating this condition is to stop any activities which place stress on the heel bone. That means that your child might need to take a break from sports like running, basketball, or gymnastics. Some non-weight bearing sports, such as swimming, can be allowed during this period.
Ice or a cold pack can be applied to reduce pain and swelling. They can be applied every 1-2 hours for periods of 15 minutes at a time. Most children can also tolerate paracetamol or ibuprofen as a pain reliever; however, you’ll need to check with your child’s doctor before giving them any medication.
Physiotherapy exercises can also be used to relieve the symptoms caused by Sever’s disease. Simple exercises, such as stretching the hamstring and calf muscles 2 to 3 times daily can be very helpful. In more severe cases, orthotics or a foot cast might be required.
Foot orthotics to reduce abnormal stress around the heel, achilles and plantar fascia. This orthotic also has to be padded in the heel to help with shock absorption.
The good news is that Sever’s disease is self-contained condition. It improves over time, and it doesn’t cause long-term symptoms or disability.
Prevention is also key. Preventing measures include avoiding overexertion, limiting time spent training on hard surfaces, and investing in good quality footwear made of shock-absorbing materials. It’s also important to keep an eye out for these symptoms, since an early diagnosis will make recovery much faster.