Overview
Sever's disease is a common cause of heel pain in adolescence. Developing, physically active ?kids? are more prone to Sever's. During puberty the calcaneus consist of two developing sites of bone known as ossification centres. These two areas are seperated by an area of cartilage known as the calcaneal apophysis. The Achilles tendon attaches the triceps surae (calf muscles) to the calcaneus (heel bone). As a child grows the calcaneus grows faster than the surrounding soft tissue, which means the Achilles tendon is pulled uncomfortably tight. This increase in strain causes inflammation and irritation of the calcaneal apophysis (growth plate) which is known as Sever's Disease. The pain is exacerbated by physical activities, especially ones involving running or jumping. Sever's disease most commonly affects boys aged 12 to 14 years and girls aged 10 to 12 years, which corresponds with the early growth spurts of puberty.
Causes
The exact cause of Severs disease is not completely understood. It is thought to be associated with an overuse type injury, in which repetitive stress from the Achilles tendon causes a portion of the growth plate to pull away from the heel. In medical terms, this is described as cyclic, micro-avulsion type fractures to the calcaneal apophyses.
Symptoms
The most prominent symptom of Sever's disease is heel pain which is usually aggravated by physical activity such as walking, running or jumping. The pain is localized to the posterior and plantar side of the heel over the calcaneal apophysis. Sometimes, the pain may be so severe that it may cause limping and interfere with physical performance in sports. External appearance of the heel is almost always normal, and signs of local disease such as edema, erythema (redness) is absent. The main diagnostic tool is pain on medial- lateral compression of the calcaneus in the area of growth plate, so called squeeze test. Foot radiographs are usually normal. Therefore the diagnosis of Sever's disease is primarily clinical.
Diagnosis
Sever condition is diagnosed by detecting the characteristic symptoms and signs above in the older children, particularly boys between 8 and 15 years of age. Sometimes X-ray testing can be helpful as it can occasionally demonstrate irregularity of the calcaneus bone at the point where the Achilles tendon attaches.
Non Surgical Treatment
See a Podiatrist. Minimise inflammation, by the use of ice, rest and reduction of activity. Minimise pain with the use of anti-inflammatory medications. Shoes have been shown to attenuate shock and reduce impact on the heel. Effective cushioning in the rear through specifcally placed cushioning units, such as GEL under the heel. A 10mm heel gradient that creates a more efficient foot posture and therefore reducing strain on the lower limb. Sever's is self limiting and only possible when the growth plate is still present, and does not exist once the growth plates have closed. Podiatrists have an important role to play in preventing and managing foot problems. Prompt action is important. Problems which are left without assessment or treatment may result in major health risks.
Sever's disease is a common cause of heel pain in adolescence. Developing, physically active ?kids? are more prone to Sever's. During puberty the calcaneus consist of two developing sites of bone known as ossification centres. These two areas are seperated by an area of cartilage known as the calcaneal apophysis. The Achilles tendon attaches the triceps surae (calf muscles) to the calcaneus (heel bone). As a child grows the calcaneus grows faster than the surrounding soft tissue, which means the Achilles tendon is pulled uncomfortably tight. This increase in strain causes inflammation and irritation of the calcaneal apophysis (growth plate) which is known as Sever's Disease. The pain is exacerbated by physical activities, especially ones involving running or jumping. Sever's disease most commonly affects boys aged 12 to 14 years and girls aged 10 to 12 years, which corresponds with the early growth spurts of puberty.
Causes
The exact cause of Severs disease is not completely understood. It is thought to be associated with an overuse type injury, in which repetitive stress from the Achilles tendon causes a portion of the growth plate to pull away from the heel. In medical terms, this is described as cyclic, micro-avulsion type fractures to the calcaneal apophyses.
Symptoms
The most prominent symptom of Sever's disease is heel pain which is usually aggravated by physical activity such as walking, running or jumping. The pain is localized to the posterior and plantar side of the heel over the calcaneal apophysis. Sometimes, the pain may be so severe that it may cause limping and interfere with physical performance in sports. External appearance of the heel is almost always normal, and signs of local disease such as edema, erythema (redness) is absent. The main diagnostic tool is pain on medial- lateral compression of the calcaneus in the area of growth plate, so called squeeze test. Foot radiographs are usually normal. Therefore the diagnosis of Sever's disease is primarily clinical.
Diagnosis
Sever condition is diagnosed by detecting the characteristic symptoms and signs above in the older children, particularly boys between 8 and 15 years of age. Sometimes X-ray testing can be helpful as it can occasionally demonstrate irregularity of the calcaneus bone at the point where the Achilles tendon attaches.
Non Surgical Treatment
See a Podiatrist. Minimise inflammation, by the use of ice, rest and reduction of activity. Minimise pain with the use of anti-inflammatory medications. Shoes have been shown to attenuate shock and reduce impact on the heel. Effective cushioning in the rear through specifcally placed cushioning units, such as GEL under the heel. A 10mm heel gradient that creates a more efficient foot posture and therefore reducing strain on the lower limb. Sever's is self limiting and only possible when the growth plate is still present, and does not exist once the growth plates have closed. Podiatrists have an important role to play in preventing and managing foot problems. Prompt action is important. Problems which are left without assessment or treatment may result in major health risks.