Sever?s disease or Sever?s lesion refers to an injury to the bone growth plate at the back of the heel bone (calcaneous) in young people, particularly those who are physically active. It usually
develops in puberty and is slightly more common in boys than girls.
Severs disease is caused by repetitive excessive force to the growing area of the heel bone, causing injury to this area. The calf muscles (soleus and gastrocnemius) are attached by the Achilles
tendon to the calcaneus (heel bone). They exert a huge force during running , jumping and landing. In children, there is a growing area in the heel bone called the apophysis and is made of relatively
weak cartilage. If there is excessive force at this relatively weak point damage occurs. This excess force can be caused by a number of factors. During the adolescent growth spurt the bones grow very
quickly. The muscles do not grow out at the same rate as the bone grows and so can become very tight. The calf muscles generate huge forces when they are used to run, jump and land. This force is
transmitted to the calcaneal apophysis (growth area). The gastrocnemius muscle spans both the ankle and knee joint. Tightness of this or any other muscles of the lower limb (hamstring or quadriceps)
cause extra force at the growing (weak) area. In active children, who undertake a lot of exercise, the repetitive high force causes damage. If your child has poor biomechanics due to poor lower limb
alignment (often caused by flat feet), the muscles of the lower limb have to work excessively hard and this can cause increased force at the tibial tubercle.
Athletes with Sever?s disease are typically aged 9 to 13 years and participate in running or jumping sports such as soccer, football, basketball, baseball, and gymnastics. The typical complaint is
heel pain that develops slowly and occurs with activity. The pain is usually described like a bruise. There is rarely swelling or visible bruising. The pain is usually worse with running in cleats or
shoes that have limited heel lift, cushion, and arch support. The pain usually goes away with rest and rarely occurs with low-impact sports such as bicycling, skating, or swimming.
Sever?s disease can be diagnosed based on your history and symptoms. Clinically, your physiotherapist will perform a "squeeze test" and some other tests to confirm the diagnosis. Some children suffer
Sever?s disease even though they do less exercise than other. This indicates that it is not just training volume that is at play. Foot and leg biomechanics are a predisposing factor. The main factors
thought to predispose a child to Sever?s disease include decrease ankle dorsiflexion, abnormal hind foot motion eg overpronation or supination, tight calf muscles, excessive weight-bearing activities
Non Surgical Treatment
Depending on the diagnosis and the severity of the pain, there a number of treatment options available. Rest, reduce activity, your child should reduce or stop any activity that causes pain, such as
sports and running. This can be a difficult option, as children are normally quite willful in pursuit of their favorite pastimes. Over the counter anti-inflammatory drugs, such as ibuprofen (found in
Nurofen), to help reduce pain and inflammation. Make certain your child does stretching exercises before play. This will often help reduce the stress on the fascia and relieve heel pain in your
child. Orthotic insoles. Orthotics made for children will help support the foot properly, and help prevent over-pronation or improper gait by supporting your child?s foot into a proper biomechanical
position. Do not hesitate to schedule an appointment with a podiatrist, should your child?s heel and foot pain persist.
The best way to prevent Sever?s disease is for your child to stay flexible and stretch the hamstring, calf muscles, and the Achilles tendon before and after activity each day. It?s important to hold
the stretches for 20 seconds and stretch both legs, even if there is only pain in one. If he or she only has smaller symptoms, like swelling and some tenderness, consider your child lucky. They may
only have to sit out for one to two weeks during the season. The best treatment is to immediately stop the activity that caused the pain. Elevate and ice the heel for 20 minutes at a time to relieve
discomfort and swelling.