Although the name might sound pretty frightening, Sever's disease is really a common heel injury that occurs in kids. It can be painful, but is only temporary and has no long-term effects. Calcaneal
apophysitis is a painful inflammation of the heel?s growth plate. It typically affects children between the ages of 8 and 14 years old, because the heel bone (calcaneus) is not fully developed until
at least age 14. Until then, new bone is forming at the growth plate (physis), a weak area located at the back of the heel. When there is too much repetitive stress on the growth plate, inflammation
can develop. Calcaneal apophysitis is also called Sever?s disease, although it is not a true ?disease.? It is the most common cause of heel pain in children, and can occur in one or both feet. Heel
pain in children differs from the most common type of heel pain experienced by adults. While heel pain in adults usually subsides after a period of walking, pediatric heel pain generally doesn?t
improve in this manner. In fact, walking typically makes the pain worse.
Sever?s disease is caused by repetitive tension and/or pressure on the growth center of the heel. Running and jumping place a large amount of pressure on the heels and can cause pain. Children with
Sever?s may limp or have an altered gait due to the pain. Risk factors for Sever's include tight calf muscles, weak ankle muscles, and alignment abnormalities at the foot and ankle. Sever?s can also
result from wearing shoes without sufficient heel padding or arch support.
Patients with Severs disease typically experience pain that develops gradually in the back of the heel or Achilles region. In less severe cases, patients may only experience an ache or stiffness in
the heel that increases with rest (especially at night or first thing in the morning). This typically occurs following activities which require strong or repetitive contraction of the calf muscles,
such as running (especially uphill) or during sports involving running, jumping or hopping. The pain associated with this condition may also warm up with activity in the initial stages of the
condition. As the condition progresses, patients may experience symptoms that increase during activity and affect performance. Pain may also increase when performing a calf stretch or heel raise
(i.e. rising up onto tip toes). In severe cases, patients may walk with a limp, have difficulty putting their heel down, or be unable to weight bear on the affected leg. Pain may also increase on
firmly touching the affected region and occasionally a bony lump may be palpable or visible at the back of the heel. This condition typically presents gradually overtime and can affect either one or
both lower limbs.
A physical exam of the heel will show tenderness over the back of the heel but not in the Achilles tendon or plantar fascia. There may be tightness in the calf muscle, which contributes to tension on
the heel. The tendons in the heel get stretched more in patients with flat feet. There is greater impact force on the heels of athletes with a high-arched, rigid foot.
Non Surgical Treatment
The aims are to reduce trauma to the heel, allow rest/recovery and prevent recurrence. Most cases are successfully treated using physiotherapy and exercises, eg to stretch the gastrocnemius-soleus
complex, to mobilise the ankle mortise, subtalar joint and medial forefoot. Soft orthotics or heel cups. Advice on suitable athletic footwear. Other modes of treatment are in severe cases,
temporarily limiting activity such as running and jumping. Ice and non-steroidal anti-inflammatory drugs (NSAIDs), which can reduce pain. In very severe cases, a short period of immobilisation (eg
2-3 weeks in a case in mild equinus position) has been suggested.
The surgeon 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. Often heel pain in children returns after it has been treated because the heel bone is still growing. Recurrence
of heel pain may be a sign of calcaneal apophysitis, or it may indicate a different problem. If your child has a repeat bout of heel pain, be sure to make an appointment with your foot and ankle