Sever's disease, or calcaneal apophysitis, is a common cause of heel pain in patients whose bones are still growing; however, it is not really a disease. The pain is caused by stress at the point
where the Achilles tendon meets tissue called the plantar fascia on the growth plate (apophysis) of the heel bone (calcaneus). Sever's affects boys more often than girls. Boys are most often affected
at age 12, and girls at age 9, though Sever's is typically seen in children and adolescents between the ages of 7 and 15.
During the growth spurt of early puberty, the bones often grow faster than the leg muscles and tendons. This can cause the muscles to become very tight and overstretched, the heel becomes less
flexible and this build-up of pressure can result in redness, swelling, tenderness and pain at the heel.
Athletes with Sever?s disease are typically aged 9 to 13 years and participate in running or jumping sports such as soccer, football, basketball, baseball, and gymnastics. The typical complaint is
heel pain that develops slowly and occurs with activity. The pain is usually described like a bruise. There is rarely swelling or visible bruising. The pain is usually worse with running in cleats or
shoes that have limited heel lift, cushion, and arch support. The pain usually goes away with rest and rarely occurs with low-impact sports such as bicycling, skating, or swimming.
The x-ray appearance usually shows the apophysis to be divided into multiple parts. Sometimes a series of small fragments is noted. Asymptomatic heels may also show x-ray findings of resporption,
fragmentation and increased density. But they occur much less often in the normal foot. Pulling or ?traction? of the Achilles tendon on the unossified growth plate is a likely contributing factor to
Sever?s disease. Excessive pronation and a tight Achilles and limited dorsiflexion may also contribute to the development of this condition.
Non Surgical Treatment
If the problem is bad enough, it is important to totally rest the symptomatic foot. Take a break from sport activity until the pain has significant improvement. Severe cases will need to be treated
with a cast boot. Anti-inflammatory treatments include Icing, Over-the-counter anti-inflammatory medicine as recommended by your pediatrician or podiatrist. Shock absorption and support. Don't go
barefoot at home, wear some type of good sandal or shoe. A significant and/or chronic case should be treated with prescription orthotics. This addresses mechanical problems that cause this problem,
Using an over-the-counter heel cushion inside of the shoe, Athletic foot taping, Stretching. Runners stretch to stretch out the calf muscle. A night splint will also help. Severe or chronic cases
respond best to prescription orthotics with specific modifications for this problem. May require a night splint. Daytime braces that may also help.
Stretching exercises can help. It is important that your child performs exercises to stretch the hamstring and calf muscles, and the tendons on the back of the leg. The child should do these
stretches 2 or 3 times a day. Each stretch should be held for about 20 seconds. Both legs should be stretched, even if the pain is only in 1 heel. Your child also needs to do exercises to strengthen
the muscles on the front of the shin. To do this, your child should sit on the floor, keeping his or her hurt leg straight. One end of a bungee cord or piece of rubber tubing is hooked around a table
leg. The other end is hitched around the child's toes. The child then scoots back just far enough to stretch the cord. Next, the child slowly bends the foot toward his or her body. When the child
cannot bend the foot any closer, he or she slowly points the foot in the opposite direction (toward the table). This exercise (15 repetitions of "foot curling") should be done about 3 times. The
child should do this exercise routine a few times daily.