Sever’s disease, also known as calcaneal apophysitis is a very common condition among young (8-15) athletic children. It is caused by movement of a growth plate in the back of the heel during activities. This usually occurs during periods of high impact sports, thus children who are active tend to complain of pain to their heel during and after sports. Sever’s disease is not a true “disease,” rather a painful swelling of the growth plate due to abnormal forces on the heel.
Cause
The growth plate located on the back of the heel, known as the physis, is firmly attached to the Achilles tendon. As children experience rapid growth during puberty, often times, the Achilles tendon will begin to pull with more force to the growth plate. In most children, the Achilles tendon and its associated muscles will growth at the same relative rate as the leg bones. However, in some individuals, the bones grow much faster than the tendons and bones, resulting in an increased pull to the growth plate. This results in a painful inflammation to the back of the heel. Especially after high impact sports
Symptoms
Symptoms of calcaneal apophysitis may include:
- Pain in the back or bottom of the heel
- Limping
- Walking on toes
- Difficulty running, jumping, or participating in usual activities or sports
- Pain when the sides of the heel are squeezed
Diagnosis
A thorough history and physical will be performed by one of our podiatrist. X-rays are usually obtained along with an analysis of the child’s range of motion and walking patterns. An MRI is also sometimes ordered to rule out other more serious conditions.
Treatment
Based on the history and physical findings, our podiatrist 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.
- Orthosis. These are used to correct any biomechanical abnormality.