Sever’s disease, also known as calcaneal apophysitis, is not actually a disease but a heel injury that affects children between the age of 8 and 15 years old and is more common in boys than girls.
How does Sever’s Disease develop?
During a growth spurt, a child’s heel bone (calcaneus) grows faster than the muscles, ligaments and tendons attaching to it. When the muscles and tendons can’t grow fast enough to keep up, they are stretched too tight.
In children who are very active, especially those children that play sports involving a lot of running and jumping on hard surfaces (for example soccer, basketball or gymnastics), extra strain can be placed on the already overstretched tendons. This leads to pain and swelling at the point where the tendons attach to the heel bone.
What are the Symptoms of Sever’s Disease?
- Pain, swelling and/or redness in one or both heels.
- It can occur on one or both sides, but in 60% of children, it occurs on both sides.
- Heel pain that gets worse after running or jumping and feels better after rest.
- The area often feels stiff with limited range of motion in the ankle, in addition to tightness of the Achilles tendon.
- The pain may be particularly bad at the beginning of the sports season or when wearing hard, stiff shoes like soccer boots.
- Tenderness and tightness at the back of the heel which feels worse when the area is squeezed.
- Walking or running with a limp or on tiptoes.
How can physiotherapy help?
The condition is self-limiting (that is, it can resolve itself without treatment) and does not cause long term damage to the foot. Symptoms typically go away after a few months. Once the child’s growth spurt ends and he/she reaches full size, Sever’s disease will not return. Having said that, however, a physiotherapist will be able to assess your child and give him/her the treatment required based on their individual symptoms and limitations in movement (bio-mechanics).
Treatment often includes:
- Recommending relative rest or modified rest. The child’s activity level should be limited only by pain.
- Ice applied at intervals over the heel.
- Stretching of the hamstring (thigh), gastrocnemius and soleus (calf) muscles, as well as the plantar fascia ligament, which is located under the foot.
- Strengthening exercises of the muscles that support the foot and ankle.
- Night-time splints provide relief from symptoms and help maintain flexibility.
- Mobilisation of the subtalar joint (ankle joint).
- Advice regarding footwear.
- Assisting with recommendations to decrease impact and shock on the heel area eg heel lifts, orthoses (all types, heel cups, heel foam), padding for shock absorption or strapping of the heel.
This article was submitted by Kate Lamprey who is the Associate Manager for Douglasdale and Fourways. Contact your Physio or make an appointment for an assessment with one of our skilled Physiotherapists in Johannesburg or Cape Town.