Sever's disease is an injury to a child's still developing foot structure, specifically an inflammation in the heel's growth plate due to muscle strain and repetitive stress. It is common in young athletes and children who have problems with pronation. Sever's Disease usually occurs in children age 8, 14 years of age when the child's bones are still in the growth stage and the growth plates have not become ossified.
Sever?s disease is common, and typically occurs during a child?s growth spurt, which can occur between the ages of 10 and 15 in boys and between the ages of 8 and 13 in girls. Feet tend to grow more quickly than other parts of the body, and in most kids the heel has finished growing by the age of 15. Being active in sports or participating in an activity that requires standing for long periods can increase the risk of developing Sever?s disease. In some cases, Sever?s disease first becomes apparent after a child begins a new sport, or when a new sports season starts. Sports that are commonly associated with Sever?s disease include track, basketball, soccer, and gymnastics. Children who are overweight or obese are also at a greater risk of developing this condition. Certain foot problems can also increase the risk, including. Over pronating. Kids who over pronate (roll the foot inward) when walking may develop Sever?s disease. Flat foot or high arch. An arch that is too high or too low can put more stress on the foot and the heel, and increase the risk of Sever?s disease. Short leg. Children who have one leg that is shorter than the other may experience Sever?s disease in the foot of the shorter leg because that foot is under more stress when walking.
Unilateral or bilateral heel pain. Heel pain during physical exercise, especially activities that require running or jumping. Increased pain level after exercise. A tender swelling or bulge on the heel that is painful on touch. Limping. Calf muscle stiffness first thing in the morning.
Sever?s disease can be diagnosed based on your history and symptoms. Clinically, your physiotherapist will perform a "squeeze test" and some other tests to confirm the diagnosis. Some children suffer Sever?s disease even though they do less exercise than other. This indicates that it is not just training volume that is at play. Foot and leg biomechanics are a predisposing factor. The main factors thought to predispose a child to Sever?s disease include a decrease in ankle dorsiflexion, abnormal hind foot motion eg overpronation or supination, tight calf muscles, excessive weight-bearing activities eg running.
Non Surgical Treatment
Treatment includes modifying activities and resting to reduce pain and inflammation and take pressure off the growth center. Ice can also be very helpful in relieving symptoms, as well as anti-inflammatory medication. A physical therapy program should be initiated to stretch tight calf muscles and strengthen the ankle muscles to relieve tension on the growth center. Shoes with padded heel surfaces and good arch support can decrease pain. Cleats may need to be avoided for some time to help reduce symptoms. The doctor may also recommend gel heel cups or supportive shoe inserts.
For children with Sever's disease, it is important to habitually perform exercises to stretch the hamstrings, calf muscles, and the tendons on the back of the leg. Stretching should be performed 2-3 times a day. Each stretch should be performed for 20 seconds, and both legs should be stretched, even if the pain is only in one heel. Heel cups or an inner shoe heel lifts are often recommended for patient suffering from Sever's disease. Wearing running shoes with built in heel cups can also decrease the symptoms because they can help soften the impact on the heel when walking, running, or standing.