Severs disease is the most common cause of heel pain in the growing athlete. If your child has ever suffered from this, you will know how uncomfortable and frustrating this condition is when all your child wants to do is get on with their sport!
What is it?
The medical name for Sever’s disease is calcaneal apophysitis- inflammation where the Achilles tendon inserts into the heel bone. Commonly affecting children between the ages of 10-14, this condition is said to be linked to both the adolescent growth spurt and to overuse. During the growth spurt, the growth of bone takes place at a faster rate than the tendons, causing a relative shortening on the tendon compared to the leg bones. This causes tension at the tendon insertion to the bone. To compound matters, the calcaneus (heel) usually matures in phases. Between the ages of 10-14, the bone is not yet fully mature making it susceptible to injury. As a final insult, when all these changes happen in an active child who is prone to overuse, the condition becomes difficult and frustrating to manage.
What are the symptoms?
- Pain or tenderness in one or both heels
- Discomfort upon awaking, or when heel is squeezed
- Pain worsens after walking or exercise
- Tight calf muscle (gastrocnemius or soleus) causing reduced ankle motion
- Pain reduced when walking on toes
What can your doctor do about it?
The first step would be to reassure the patient that the condition will always settle, usually within 6 -12 months, but occasionally up to 2 years. Other recommendations include:
- Activity modification. Change to activity that is pain free.
- Inserting heel raise into shoe- to lessen the tension in the Achilles tendon
- Stretching of calf muscles
- Oral anti-inflammatory medication. (Steroid injections are NOT useful in this condition).
- Assessment and correction of biomechanical abnormalities e.g. flat foot would be corrected using orthotics (insole)
Are there any long term effects?
You can rest assured that there is no long term disability expected with Sever’s. As mentioned before, the condition is self-limiting and goes away when growth in the heel bone is complete. Encourage your child to continue taking part in sport for as long as he/she can tolerate it.
Sever’s disease is one of several different ‘osteochondroses’ that can occur in the body. In the next medical article, we take a look at a similar condition that affects the knee: Osgood-Schlatters Disease.
References available on request.