Sever’s Disease (calcaneal apophysitis) is an overuse syndrome
It is thought to be a traction injury, where the Achilles tendon and Plantar fascia pull in opposite directions. Sever’s occurs in children aged 8 to 16 years old.
In children, the heel bone is made up of 2 bones, with a growth plate of cartilage in between the sections, holding these 2 bones together. As the cartilage expands, the edges of it eventually turn to bone, and finally the gap closes. This usually occurs within the first 13-15 years of life. However, because these bones are connected by cartilage they are weaker than normal bones. This is why they are very vulnerable to injury.
Contraction of the calf muscles along with the rapid growth of the leg bone (tibia), decreases ankle motion and increases strain on the heel area. This puts strain on the Achilles tendon. Injury results from repetitive pulling through the heel bone by the Achilles and the traction forces from the plantar fascia.
Sever’s is recognized by pain in the back and lower regions of the heel. It usually starts during or immediately following the child’s growth spurt, and/or in very active individuals. The child will usually have pain during or following participation in sport, and will often be seen limping off the field or court.
Symptoms of Sever’s
- Painful heel
- No swelling or warmth
- Night pain is absent
- Pain is worse with increased activity
- Pain which is usually relieved by rest
- Children often hobble or limp from the sports field
Care and Management
- See a Podiatrist
- Minimise inflammation, by the use of ice, rest and reduction of activity
- Minimise pain with the use of anti-inflammatory medications
- Shoes have been shown to attenuate shock and reduce impact on the heel
- Firm heel counter
- Dual density EVA midfoot and rearfoot control
- Effective cushioning in the rear through specifically placed cushioning units, such as GEL under the heel
- A 10mm heel gradient that creates a more efficient foot posture and therefore reducing strain on the lower limb
Sever’s is self limiting and only possible when the growth plate is still present, and does not exist once the growth plates have closed.
When to see a Podiatrist
Podiatrists have an important role to play in preventing and managing foot problems. Prompt action is important. Problems which are left without assessment or treatment may result in major health risks.