A young athlete's setback: Sever's Disease
We all encourage our children to participate in sport-related activities for numerous beneficial reasons. Sometimes they are playing competitively.
But how do you know if it is too much for them?
First, they will complain about heel pain. Then they may walk funny.
What's going on? This is called Sever's Disease. Also known as calcaneal apophysitis, it is a prevalent condition that causes heel pain among many active children. This occurs when the heel growth plate, is stressed or agitated during the growing stages of adolescence.
A growth plate is a space at the ends of a bone that allows space for the bone to grow. These plates will be present in the growing stages of a child; the first few years after birth and the teenage years. Adolescence occurs between age 8 to 13 in girls, and 10 to 12 years old in boys. Sometimes the heel bone grows faster than its surrounding tendons and muscles; this causes tightness in the soft tissues.
After a period of time, the tendon that attaches to the growth plate, called Achilles tendon, will tighten up to the point of injury.
What caused it? This tightness caused by physical activities with lots of running and jumping; especially sports on hard surfaces, such as track, basketball, gymnastics and field sports. It can also be a result of standing for prolonged periods of time, or poor-fitting shoes.
Other conditions that will increase the chances of Sever's:
Flat/high arch - heel angle causes tightness and shortening of Achilles tendon
Short leg syndrome - when one leg is relatively shorter than the other, the foot of the short leg will bend downwards to reach the ground, which pulls the Achilles
Overweight/Obesity - additional pressure on growth plate due to excessive weight
Signs and symptoms
- pain or tenderness in one or both heel; can extend to sides and bottom of heel
- swelling and redness
- walking difficulty or unusual walking pattern (e.g., limp, tiptoe walk)
- discomfort/stiffness upon waking
- discomfort when heel is squeezed on both sides
These symptoms can worsen during or after activity and can get better with rest.
How to treat it? First priority, pain relief. Perform RICE (rest, ice, compression and elevation), and restrict or avoid all activities that induce pain until there are no symptoms. If needed, have them take over-the-counter medicine for pain relief and swelling like Tylenol and Advil. (Important Note: Aspirin should not be given due to risk of Reye syndrome.)
In severe cases, their feet may need to be put into a cast for 2 to 12 weeks.
For long term treatment, they should perform foot & leg stretches and strengthening exercises. Elastic wrap or compression sleeves can help decrease pain and swelling in the heel.
If Sever's is caused by other conditions:
Flat/high arch or pronated foot - orthotic devices are recommended
Overweight/obesity - weight loss program prescribed by a dietitian or similar specialist.
Recovery and recurrence
Majority of kids can resume in their sport when the symptoms are no longer present, and the recovery is generally fast. But if long-term precautions are not taken, the condition, if not others, can reappear.
Proper shoes are very important as it minimizes pressure on the heel. Consistent stretching and icing routine after activity is effective as a preventative measure.
Good news about Sever's is that there will be no chances of recurrence when growth plate fuses with the heel bone (ie. foot stops growing); this generally occurs at age of 15.
For an assessment or consultation, feel free to call us today to book an appointment with Silvia!