Despite its name, sever’s disease is not so much a disease as it is a painful growth-related condition in children. It is medically referred to as calcaneal apophysitis, and is often referred to as ‘growing pains’ at the back of the heel. It describes the inflammation and abnormal tension (pull) on the heel bone and its growth plate in kids, particularly between the ages of 8 and 14.
Growth plates are located on the ends of growing bones and will eventually turn into solid bone when we reach full maturity. As we grow, our bones, muscles and tissues all grow and lengthen too. In Sever’s, the pull from Achilles tendon (which connects the calves to the back of the heel) causes the nearby growth plate to become irritated and inflamed, and hence painful.
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What causes Sever’s Disease?
There are various influences that can damage and irritate to the growth plate at the back of the heel and cause painful symptoms. These include:
- Tight calf muscles
- Faster rate of bone growth than muscle growth
- Increasing the intensity of physical activities
- Running sports
- Soccer boots and low-heeled shoes
- Hard surfaces
- Increased impact forces to the heel bone
What are the symptoms?
Symptoms typically occur during a period of growth and include:
- Pain at the back of the heel that can be sharp or aching
- Pain occurs during (or after) sports or physical activity
- Abnormal tightness in the back of the legs down to the heel
- Swelling at the back of the heel
- Pain that is reduced with rest and ice, but comes back with activity
How is Sever’s disease treated?
The key to managing sever’s is not only to settle the painful symptoms, but also to treat the cause and reduce the tension at the back of the heel where the growth plate is. Initially, the PRICE (protection, rest, ice, compression and elevation) principles can be used to manage painful symptoms. Following this, treatment may include:
- Orthotics to correct any biomechanical or alignment issues and minimise the tension at the back of the heel
- Stretching tight muscles such as the Achilles tendon to reduce their pull on other structures
- Strengthening weak muscles to help support and stabilise the foot
- Footwear assessment – to ensure the footwear is helping and not hindering recovery. Even good, supportive shoes may have a low set heel which can place more tension on the back of the heel from the Achilles tendon
- Activity modification to prevent the onset of painful symptoms throughout your treatment
Your podiatrist will create the best management plan based on your symptoms and regular activities. It is important to listen to your body and stop if an activity begins to cause you pain to maximise your recovery.
