What Exactly Is Severs Disease?

Overview

The calcaneal apophysis is a growth center where the Achilles tendon and the plantar fascia attach to the heel. It first appears in children aged 7 to 8 years. By ages 12 to 14 years the growth center matures and fuses to the heel bone. Injuries can occur from excessive tension on the Achilles tendon and the plantar fascia, or from direct impact on the heel. Excessive stress on this growth center can cause irritation of the heel, also called Sever?s disease.

Causes

Sever?s disease is common, and typically occurs during a child?s growth spurt, which can occur between the ages of 10 and 15 in boys and between the ages of 8 and 13 in girls. Feet tend to grow more quickly than other parts of the body, and in most kids the heel has finished growing by the age of 15. Being active in sports or participating in an activity that requires standing for long periods can increase the risk of developing Sever?s disease. In some cases, Sever?s disease first becomes apparent after a child begins a new sport, or when a new sports season starts. Sports that are commonly associated with Sever?s disease include track, basketball, soccer, and gymnastics. Children who are overweight or obese are also at a greater risk of developing this condition. Certain foot problems can also increase the risk, including. Over pronating. Kids who over pronate (roll the foot inward) when walking may develop Sever?s disease. Flat foot or high arch. An arch that is too high or too low can put more stress on the foot and the heel, and increase the risk of Sever?s disease. Short leg. Children who have one leg that is shorter than the other may experience Sever?s disease in the foot of the shorter leg because that foot is under more stress when walking.

Symptoms

A few signs and symptoms point to Sever?s disease, which may affect one or both heels. These include Pain at the heel or around the Achilles tendon, Heel pain during physical exercise, especially activities that require running or jumping, Worsening of pain after exercise, A tender swelling or bulge on the heel that is sore to touch, Calf muscle stiffness first thing in the morning, Limping, A tendency to tiptoe.

Diagnosis

Low-grade inflammation of the calcaneal apophysis cannot be seen on x-ray. Therefore, although x-rays are often done to rule out bony injuries in children with Sever's disease these x-rays are usually normal. Advanced Sever's disease can be seen on x-ray but usually the problem is treated before it reaches this point. Other diagnostic tests, such as bone scans or MRI's, are not usually required in typical cases of Sever's disease. These, or other tests, may be required to rule out other conditions, such as stress fractures of the calcaneus or other bony abnormalities that can mimic Severs disease.

Non Surgical Treatment

Rest is best to allow healing .Only do as much exercise as able without causing pain. Many children can continue to play sports but if pain is severe then stopping the activity may be the only way to allow the pain to settle. The child might be able to do things that do not put pressure on the heel, such as swimming and cycling. Ice and cold therapy may be useful to reduce pain and swelling, particularly following activity or sport. The area should be iced until it feels cold not ?frozen?. Never apply ice directly onto the skin, as this may cause tissue damage. Medication. The following will help treat your child?s pain. Paracetamol (see bottle for instructions) Ibuprofen (see bottle for instructions). Exercises, perform foot and leg exercises to stretch and strengthen the leg muscles & tendons. Increase calf flexibility by doing calf stretches several times per day. Protect the heel, your shoes might need a heel lift or arch support. Select a shoe with good arch support and heel lift if possible. Take it one step at a time: gradually resume running and impact activities as symptoms allow.

Surgical Treatment

The surgeon may select one or more of the following options to treat calcaneal apophysitis. Reduce activity. The child needs to reduce or stop any activity that causes pain. Support the heel. Temporary shoe inserts or custom orthotic devices may provide support for the heel. Medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, help reduce the pain and inflammation. Physical therapy. Stretching or physical therapy modalities are sometimes used to promote healing of the inflamed issue. Immobilization. In some severe cases of pediatric heel pain, a cast may be used to promote healing while keeping the foot and ankle totally immobile. Often heel pain in children returns after it has been treated because the heel bone is still growing. Recurrence of heel pain may be a sign of calcaneal apophysitis, or it may indicate a different problem. If your child has a repeat bout of heel pain, be sure to make an appointment with your foot and ankle surgeon.

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