Dealing With Severs Disease

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Overview

Severs Disease is a common cause of heel pain in children. It is seen most commonly in children aged 5 - 11 years old. Children with Severs Disease will complain of heel pain that increases with activity. The pain is often relieved by rest, although some children will continue to have pain with regular activities, such as walking. Severs Disease has much in common with Osgood-Schlatter Disease. Both are described as being a traction apophysitis.

Causes

When a baby is born, most of the bones are still cartilage with only some starting to develop into bone. When the heel (calcaneus) starts to develop bone, there is generally one large area of development that starts in the center of the cartilage heel. This area of bone spreads to 'fill up' the cartilage. Another area of bone development (ossification) occurs at the back of the heel bone. These two areas of developing bone will have an area of cartilage between them, this is how the bone grows in size. At around age 16, when growth is nearly complete, these two bony areas fuse together. Sever's disease or calcaneal apophysitis is usually considered to be due to damage or a disturbance in this area of growth.

Symptoms

The most common symptoms of Sever?s involves pain or tenderness in one or both heels. This pain usually occurs at the back of the heel, but can also extend to the sides and bottom of the heel. A child with Sever?s may also have these common problems. Heel pain with limping, especially after running. Difficulty walking. Discomfort or stiffness in the feet upon awaking. Swelling and redness in the heel. Symptoms are usually worse during or after activity and get better with rest.

Diagnosis

A Podiatrist can easily evaluate your child?s feet, to identify if a problem exists. Through testing the muscular flexibility. If there is a problem, a treatment plan can be create to address the issue. At the initial treatment to control movement or to support the area we may use temporary padding and strapping and depending on how successful the treatment is, a long-term treatment plan will be arranged. This long-term treatment plan may or may not involve heel raises, foot supports, muscle strengthening and or stretching.

Non Surgical Treatment

Sever?s disease will go away on its own with rest or after heel bone growth is complete, usually within 2 to 8 weeks after the heel pain or discomfort appears. Sever?s disease is not expected to cause long-term problems, though symptoms may linger for up to several years in severe cases. Certain conservative care measures may be helpful in treating this health problem, including avoiding activities that provoke pain or discomfort, elevating the leg while at rest, performing hamstring and calf muscle stretches two to three times per day, undergoing physical therapy, using cold therapy, using an elastic wrap or compression stocking, Avoiding footwear with heel elevation, toe spring, and toe taper, and instead favoring footwear that?s completely flat and widest at the ends of the toes. More aggressive treatment measures, including over-the-counter anti-inflammatory medication (e.g. ibuprofen), steroid injections, and surgery, may be indicated in certain cases. Addressing the footwear component of this health problem is an important part of a well-rounded Sever?s disease treatment plan. Optimal footwear for preventing or treating this problem is flat, wide (widest at the ends of the toes), and flexible in the sole. Open-back footwear (such as certain Crocs models) may be particularly helpful for kids and teens with Sever?s disease.

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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