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Sever's Disease

What it is?

 

Sever’s disease (calcaneal apophysitis) is an inflammation of the growth plate in the calcaneus (heel) and is a very common cause of heel pain in growing children.

This growth area serves as the attachment point for the Achilles tendon that connects the calf muscles to the heel bone. Sever’s disease is seen in children who are very physically active as the repetitive stress to the heel in running, jumping, and other high-impact activities can cause pain and inflammation in this growth area.  It most often occurs during abrupt and quick growth spurts, when bones, muscles, tendons, and other structures are changing rapidly. 

Who gets it?

  • Children and adolescents who participate in sports or are very active. Sports like athletics, football, tennis and any running and jumping sports are at an increased risk.

  • Boys 10-15-year-olds and Girls 7-13-year-olds

  • However, less active adolescents may also experience this problem, especially if they wear very flat shoes.

In most cases, Sever’s disease can be managed and treated well with the correct advice, treatment and management. 

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Signs or Symptoms

 

If you find that your child has some pain after or during exercise in the heel area they may have the start of sever's disease. You may also notice that there is a change in walking (limping) or an abnormal gait pattern due to pain. Pain can be at the heel but may also be felt under the foot at the arch or come up the calf.

 

The main signs or symptoms you may see are;

  • Difficulty with walking- possible limp.

  • May start to walk more on the tiptoes to avoid pressure on the heel

  • Discomfort if the heel is squeezed on both sides

  • Can sometimes be swelling at the heel

  • When walking may keep feet very stiff.

  • Avoiding running or other activity

Treatment

 

Treatment for Sever’s disease primarily focuses on reducing pain and swelling. This generally requires reducing exercise until your child can enjoy the activity without discomfort or significant pain afterwards. During this time measures can be put into place to help reduce the pain quickly, and help them return to sport or activity safely.  Occasionally rest may be required for several months if it is persistent, but many cases will just require good management and a graduated return to sport when pain-free.  

Treatments can incorporate a range of interventions such as

  • Heel pads/Heel cups. These are inserted into footwear to help reduce impact and provide some cushioning. 

  • Ice- after exercise can help reduce the sensation of pain, making the heel feel more comfortable.

  • Footwear with a slightly elevated heel. These may be trainers that are also soft that can elevate the heel and reduce pressure on the growth plate and Achilles tendon.

  • Medication. Drugs like ibuprofen and paracetamol can help reduce pain and swelling but speak to your Doctor or Pharmacist if required.

  • Taping at the heel can help reduce stress at the growth plate and help in reducing pain. 

  • Exercises can help stretch muscles and improve strength if required. 

  • MoonBoot- This can be used in severe cases when the child is struggling with normal walking. 

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