CAUSES AND TREATMENT OF SEVER'S DISEASE

What is Sever's disease?

Sever's disease is a common cause of heel pain in growing kids, especially those who are physically active. It usually occurs during the growth spurt of adolescence, the approximately 2-year period in early puberty when kids grow most rapidly. This growth spurt can begin any time between the ages of 8 and 13 for girls and 10 and 15 for boys. Sever's disease rarely occurs in older teens because the back of the heel usually finishes growing by the age of 15, when the growth plate hardens and the growing bones fuse together into mature bone.
 
Cause 
 
During the growth spurt of early puberty, the heel bone (also called the calcaneus) sometimes grows faster than the leg muscles and tendons. This can cause the muscles and tendons to become very tight and overstretched, making the heel less flexible and putting pressure on the growth plate. The Achilles tendon (also called the heel cord) is the strongest tendon that attaches to the growth plate in the heel. Over time, repeated stress (force or pressure) on the already tight Achilles tendon damages the growth plate, causing the swelling, tenderness, and pain of Sever's disease.

Such stress commonly results from physical activities and sports that involve running and jumping, especially those that take place on hard surfaces, such as track, basketball, soccer, and gymnastics.

Sever's disease also can result from standing too long, which puts constant pressure on the heel. Poor-fitting shoes can contribute to the condition by not providing enough support or padding for the feet or by rubbing against the back of the heel.

Signs and Symptoms

The most obvious sign of Sever's disease is pain or tenderness in one or both heels, usually at the back. The pain also might extend to the sides and bottom of the heel, ending near the arch of the foot.

A child also may have these related problems:

  • swelling and redness in the heel
  • difficulty walking
  • discomfort or stiffness in the feet upon awaking
  • discomfort when the heel is squeezed on both sides
  • an unusual walk, such as walking with a limp or on tiptoes to avoid putting pressure on the heel

Symptoms are usually worse during or after activity and get better with rest.

Treatment 

The immediate goal of treatment is pain relief. Because symptoms generally worsen with activity, the main treatment for Sever's disease is rest, which helps to relieve pressure on the heel bone, decreasing swelling and reducing pain.

The chiropodist might also recommend that a child with Sever's disease:

  • perform foot and leg exercises to stretch and strengthen the leg muscles and tendons
  • elevate and apply ice (wrapped in a towel, not applied directly to the skin) to the injured heel for 20 minutes two or three times per day, even on days when the pain is not that bad, to help reduce swelling
  • use an elastic wrap or compression stocking that is designed to help decrease pain and swelling

As directed by the chiropodist, a child should cut down on or avoid all activities that cause pain until all symptoms are gone, especially running barefoot or on hard surfaces because hard impact on the feet can worsen pain and inflammation. The child might be able to do things that do not put pressure on the heel, such as swimming and biking, but check with a doctor first.

Brought to you by Doctor John A. Hardy, owner of Toronto's foot clinic, Academy Foot and Orthotics Clinic.

 

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