Sever?s disease is an inflammation of the growth plate in the heel, which is an area at the end of the developing bone where cartilage gradually turns into bone as kids grow. In fact, kids grow so
rapidly at this age that their muscles and tendons can?t quite keep up with their feet and legs. This leaves the muscles and tendons tight and overstretched, particularly the Achilles tendon that
connects the heel to the calf muscles. In fast-growing preteen and teen athletes, it can put so much pressure on the heel?s growth plate that it swells and becomes tender.
Heel pain is very common in children due to the fact they are cnstantly growing. In most children, the heel bone (the calcaneus) is not fully developed until the age of 14 or older. Until then, new
bone is forming at the growth plate of the foot (the apophysis, located at the back of the heel), an area which is softer than others due to its role in accommodating the growth. Repetitive stress on
the growth plate due to walking, running and sports causes inflammation in the heel area. Because the heel's growth plate is sensitive, repeated running and pounding on hard surfaces can result in
pediatric heel pain. Children and adolescents who take part in a lot of sport are especially vulnerable. Over-pronation (fallen arches and rolling inwards of the feet) will increase the impact on the
growth plate and is therefore a significant cause and a major contributing factor to heel pain in children.
The typical clinical presentation is an active child (aged 9-10 years) who complains of pain at the posterior heel that is made worse by sports, especially those involving running or jumping. The
onset is usually gradual. Often, the pain has been relieved somewhat with rest and consequently has been patiently monitored by the patient, parents, coaches, trainers, and family physicians, in the
expectation that it will resolve. When the pain continues to interfere with sports performance and then with daily activities, further consultation is sought. It should be kept in mind that failure
to instruct patients and parents that continual pain, significant swelling or redness, and fever are not signs of Sever disease and therefore require further evaluation could result in failure to
diagnose a condition with much more serious long-term consequences.
Sever condition is diagnosed by detecting the characteristic symptoms and signs above in the older children, particularly boys between 8 and 15 years of age. Sometimes X-ray testing can be helpful as
it can occasionally demonstrate irregularity of the calcaneus bone at the point where the Achilles tendon attaches.
Non Surgical Treatment
The practitioner should inform the patient and the patient?s parents that this is not a dangerous disorder and that it will resolve spontaneously as the patient matures (16-18 years old). Treatment
depends on the severity of the child?s symptoms. The condition is self-limiting, thus the patient?s activity level should be limited only by pain. Treatment is quite varied. Relative Rest/ Modified
rest or cessation of sports. Cryotherapy. Stretching Triceps Surae and strengthen extensors. Nighttime dorsiflexion splints (often used for plantar fasciitis, relieve the symptoms and help to
maintain flexibility). Plantar fascial stretching. Gentle mobilizations to the subtalar joint and forefoot area. Heel lifts, Orthoses (all types, heel cups, heel foam), padding for shock absorption
or strapping of heel to decrease impact shock. Electrical stimulation in the form of Russian stimulation sine wave modulated at 2500 Hz with a 12 second on time and an 8 second off time with a 3
second ramp. Advise to wear supportive shoes. Ultrasound, nonsteroidal anti-inflammatory drugs. Casting (2-4 weeks) or Crutches (sever cases). Corticosteroid injections are not recommended.
Ketoprofen Gel as an addition to treatment. Symptoms usually resolve in a few weeks to 2 months after therapy is initiated. In order to prevent calcaneal apophysitis when returning to sports (after
successful treatment and full recovery), icing and stretching after activity are most indicated. Respectable opinion and poorly conducted retrospective case series make up the majority of evidence on
this condition. The level of evidence for most of what we purport to know about Sever?s disease is at such a level that prospective, well-designed studies are a necessity to allow any confidence in
describing this condition and its treatment.