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
Mechanically, the heel takes a beating. And the apophyseal bone is located near the point of impact for the heel bone at heel strike and with most weight bearing activities. This includes running,
jumping and walking. Heavy impact activities like soccer, football and gymnastics are commonly associated with this problem. In addition to this, there is traction on this apophyseal bone and the
associated physeal line of growth cartilage. This traction on the apopysis (island of bone) along with the impact of weight bearing activities can lead to inflammation and pain. Tight Achilles and
calf muscles also can contribute to this problem, and why stretching is discussed later.
The typical clinical presentation is an active child (aged 9-10 years) who complains of pain at the posterior heel that is made worse by sports, especially those involving running or jumping. The
onset is usually gradual. Often, the pain has been relieved somewhat with rest and consequently has been patiently monitored by the patient, parents, coaches, trainers, and family physicians, in the
expectation that it will resolve. When the pain continues to interfere with sports performance and then with daily activities, further consultation is sought. It should be kept in mind that failure
to instruct patients and parents that continual pain, significant swelling or redness, and fever are not signs of Sever disease and therefore require further evaluation could result in failure to
diagnose a condition with much more serious long-term consequences.
Sever?s disease is diagnosed based on a doctor?s physical examination of the lower leg, ankle, and foot. If the diagnosis is in question, the doctor may order x-rays or an MRI to determine if there
are other injuries that may be causing the heel pain.
Non Surgical Treatment
A physiotherapist will assess your pain, presentation and biomechanics. They can then treat your sever?s disease with hands on techniques which may include massage, manual therapy and taping. Your
physiotherapist can then provide advice on what you can do at home to further progress your treatment, this may include stretching, strengthening and activity modification. In some cases orthotic
prescription may be of benefit.
If the child has a pronated foot, a flat or high arch, or another condition that increases the risk of Sever's disease, the doctor might recommend special shoe inserts, called orthotic devices, such
as heel pads that cushion the heel as it strikes the ground, heel lifts that reduce strain on the Achilles tendon by raising the heel, arch supports that hold the heel in an ideal position. If a
child is overweight or obese, the doctor will probably also recommend weight loss to decrease pressure on the heel. The risk of recurrence goes away on its own when foot growth is complete and the
growth plate has fused to the rest of the heel bone, usually around age 15.