Pain in the heel of a child's foot, typically brought on by some form of injury or trauma, is sometimes Sever's Disease. The disease often mimics Achilles tendonitis, an inflammation of the tendon
attached to the back of the heel. A tight Achilles tendon may contribute to Sever's Disease by pulling excessively on the growth plate of the heel bone. This condition is most common in younger
children and is frequently seen in the active soccer, football or baseball player. Sport shoes with cleats are also known to aggravate the condition. Treatment includes calf muscle stretching
exercises, heel cushions in the shoes, and/or anti-inflammatory medications. Consult your physician before taking any medications.
Severs disease is caused by repetitive excessive force to the growing area of the heel bone, causing injury to this area. The calf muscles (soleus and gastrocnemius) are attached by the Achilles
tendon to the calcaneus (heel bone). They exert a huge force during running , jumping and landing. In children, there is a growing area in the heel bone called the apophysis and is made of relatively
weak cartilage. If there is excessive force at this relatively weak point damage occurs. This excess force can be caused by a number of factors. During the adolescent growth spurt the bones grow very
quickly. The muscles do not grow out at the same rate as the bone grows and so can become very tight. The calf muscles generate huge forces when they are used to run, jump and land. This force is
transmitted to the calcaneal apophysis (growth area). The gastrocnemius muscle spans both the ankle and knee joint. Tightness of this or any other muscles of the lower limb (hamstring or quadriceps)
cause extra force at the growing (weak) area. In active children, who undertake a lot of exercise, the repetitive high force causes damage. If your child has poor biomechanics due to poor lower limb
alignment (often caused by flat feet), the muscles of the lower limb have to work excessively hard and this can cause increased force at the tibial tubercle.
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.
In Sever's disease, heel pain can be in one or both heels. It usually starts after a child begins a new sports season or a new sport. Your child may walk with a limp. The pain may increase when he or
she runs or jumps. He or she may have a tendency to tiptoe. Your child's heel may hurt if you squeeze both sides toward the very back. This is called the squeeze test. Your doctor may also find that
your child's heel tendons have become tight.
Non Surgical Treatment
If your child have Sever's disease, the following is suggested, cut back on sporting activities, don't stop, just reduce the amount until symptoms improve (if the condition has been present for a
while, a total break from sport may be needed later) avoid going barefoot, a soft cushioning heel raise is really important (this reduces the pull from the calf muscles on the growth plate and
increases the shock absorption, so the growth plate is not knocked around as much). Stretch the calf muscles, provided the stretch does not cause pain in the area of the growth plate). The use of an
ice pack after activity for 20mins is often useful for calcaneal apophysitis - this should be repeated 2 to 3 times a day.
Receiving the initial diagnosis of Sever?s disease can be scary, and while the situation is painful, there is good news. If treated properly and quickly, Sever?s disease is temporary and will have no
long-term effects on the athlete.