What is Sever’s Disease?
Sever’s disease is not a true disease! It is the most common cause of heel pain in growing children.
The medical term for Sever’s is ‘calcaneal apophysitis’.
(Calcaneus = heel, apophysitis = growth plate irritation)
Sever’s is a common growth related condition characterised by pain in one or both heels in girls between 8 and 11 years and boys between 10 and 12 years who are very active.
Young people who we see with this condition often take part in high impact sports such as gymnastics, aerobics, football and soccer.
What causes Sever’s?
As young people go through growth spurts, hormonal changes and rapid growth of bones often mean increased tightness in muscles, resulting in a pull by the Achilles tendon on the growth plate of the heel.
All of those high impact sports means a lot of force goes through this area, resulting in even more of a pull and subsequent inflammation-type changes to the growth plate.
As a parent, you may notice your child limping while walking or running awkwardly. Your child may also start walking on their toes and start complaining of pain in their heel or ankle.
How do we diagnose Sever’s?
It’s important for us as Physiotherapists to ascertain if anything else may be causing your child’s pain. We’ll use various tests to rule out any other injuries.
Usually when there is pain upon testing a specific site on the heel as well as restriction in the foot and calf, we can give this diagnosis without the need for a scan.
Management
There are a few things that we will do to try and help your pain in the short term based on experience and the best current research:
Modifying activity and self-management of pain - In the first instance it is wise for us to come up with the best way for you to help settle your pain, whether that’s doing no sport or reducing the amount that you do while the pain settles. Ice can be effective for reducing pain levels.Lengthen your muscles and loosen stiff joints – In the initial phase we will use manual techniques such as soft tissue release and joint mobilisations to reduce the load on the growth plate and we find that it can greatly help with pain. We may also start to introduce gentle stretching as tolerated.Heel lifts for shoes - We will often give your heel a lift to reduce the pull and help with pain when walking.Strengthening and control! – We usually pick up on a few strength and stability issues in the lower limbs. Making sure that your muscles are working well for you during your day to day activities can make a huge difference to pain levels.
After initial management we usually find that pain improves, but while your child is going through growth spurts, the pain is likely to get better and worse until they stop growing. You’ll be pleased to know that Sever’s doesn’t affect you later down the track once the growth plate is fully matured.
Is there a way to prevent Severs?
Not always, but Sever's disease may be prevented by maintaining good joint and muscle flexibility in the years leading up to, and during, your child’s growth spurts. And don’t forget about good quality, supportive footwear!
In conclusion
Sever’s disease is very common and it shouldn’t worry you once we rule out other injuries, improve pain and put a good management plan into place.
It’s important for your child to listen to their body, but mild discomfort during sport down the track won’t cause long term damage. If your child starts to limp and their performance is being hampered, it could be time to decrease their overall load until symptoms settle.