Sever?s disease occurs in children when the growing part of the heel is injured. This growing part is called the growth plate. The foot is one of the first body parts to grow to full size. This
usually occurs in early puberty. During this time, bones often grow faster than muscles and tendons. As a result, muscles and tendons become ?tight.? The heel area is less flexible. During
weight-bearing activity (activity performed while standing), the tight heel tendons may put too much pressure at the back of the heel (where the Achilles tendon attaches). This may injure the
There are several theories surrounding the cause of Sever?s disease. These range from a tight Achilles tendon, to micro stress fractures of the heel, to biomechanical mal-alignment, to trauma, to
flat feet, and even to obesity. But the prevailing theory suggests the onset of Sever?s disease occurs when the child's growth plate is at its weakest, while a tightened Achilles tendon pulls
repeatedly on the growth plate, such as during AGS.
Pain is reproduced through a gentle squeeze of the back of the heel. Children may present with a limp or ?Bouncy gait?. Pain is worse barefoot and often present in the mornings and post exercise. The
pain is located at the back of the heel, with localized swelling of the area.
A doctor or other health professional such as a physiotherapist can diagnose Sever?s disease by asking the young person to describe their symptoms and by conducting a physical examination. In some
instances, an x-ray may be necessary to rule out other causes of heel pain, such as heel fractures. Sever?s disease does not show on an x-ray because the damage is in the cartilage.
Non Surgical Treatment
The surgeon may select one or more of the following options to treat calcaneal apophysitis. Reduce activity. The child needs to reduce or stop any activity that causes pain. Support the heel.
Temporary shoe inserts or custom orthotic devices may provide support for the heel. Medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, help reduce the pain and
inflammation. Physical therapy. Stretching or physical therapy modalities are sometimes used to promote healing of the inflamed issue. Immobilization. In some severe cases of pediatric heel pain, a
cast may be used to promote healing while keeping the foot and ankle totally immobile. Often heel pain in children returns after it has been treated because the heel bone is still growing. Recurrence
of heel pain may be a sign of calcaneal apophysitis, or it may indicate a different problem. If your child has a repeat bout of heel pain, be sure to make an appointment with your foot and ankle