Sever’s Disease - the most common cause for heel pain in children.
What is Sever’s Disease
Sever’s disease, also known as calcaneal apophysitis, is a painful condition of the heel experienced by school children.
It occurs when changes at the calcaneal apophysis (growth plate at the back of the heel) is pulled on by the Achilles tendon (the part of the calf muscle that attaches to the heel).
The inflammation that is caused by the opposite pulling of these two structures are what causes pain.
It is the most common cause of heel pain in physically active children and is worsened by walking, running and jumping.
What school-aged children are typically affected by Sever’s Disease?
Sever’s commonly affect children between the ages of 8 to 15 years old, with the average case being 11 years old.
Boys are three times more likely to be affected compared to girls as well.
60% of the time both heels are affected, though it can start out as just one heel.
The sports that are more prone to bring on Sever’s are soccer, basketball, gymnastics and running/ athletics.
How is Sever’s disease diagnosed?
There are currently no standardised testing methods for accurately diagnosing Sever’s disease.
Diagnosis is generally made from the description of the condition and some additional orthopaedic testing.
X-rays may be used but it is not considered a reliable method as bony inflammation may not always be seen on imaging. It is however really useful in ruling out other pathologic conditions that may be mimicking Sever’s disease like cysts and fractures.
How Can Sever’s be treated?
Conservative therapy is the first line of treatment for Sever’s. Taping, heel lifts and orthotic intervention are commonly used.
Treatment for Sever’s Disease is often passive, as it generally will resolve with rest. Alternatively, activity modification can also help speed recovery up. The pain that comes from the structures involved will also go away when the inflamed growth plate hardens and becomes bone.
Improving Overall Flexibility
Children with Sever’s disease will generally have limited or restricted ankle joint movement especially in dorsiflexion (the ability to point their foot towards their head) and an underlying biomechanical deformity of variable nature. This is why increased activity will worsen the pain.
Chiropractic may help with improving joint mobility as well as address other underlying tightness that may be causing Sever’s.
Chiropractic manipulations and techniques are modified to suit different body types, especially when it comes to kids.
Adjusting the level of intensity with sports
As Sever’s is common in children who participate in lots of sports, it’s important to discuss with everyone involved the impact of continuing on with high level sports.
The 10% rule with training may be used to ensure loading on the joints happens gradually.
The 10% rule is limiting the training frequency, intensity and volume at no more than 10% per week.
Prevention is better than cure!
Maintenance care is often missed in school-children active in sports as they normally heal quickly and bounce back.
The best thing to do with Sever’s especially in children who are active or competing in high level sports is to stop it before it starts.
Prevention strategies such as proper warm up, proprioceptive awareness, increased flexibility and age appropriate muscle strengthening should be made part of management, especially before pain starts to develop.
In some cases, additional advice regarding various supplements or vitamins intake may also help keep pain at bay.
