Severs Disease – heel pain in children

Growing feet are often placed under tremedous stress with busy schedules in sport.
Their innate energy allows them to be on the go all the time, their self limiting ability is retarded by enthusiasm, demand and peer pressure to participate in their chosen activity. This is more prevalent in schools that place a high regard for sport and competitiveness.

Severs disease – a bad sounding name, describes a disturbance to the growth plate of the heel. It belongs to a group of several growth plate injuries called Osteochondritis that commonly occur in growing children, particularly the active ones.

It occurs commonly from 10 years old upwards and will eventually stop when the growth plates finally fuse as the bones reach full growth at 14-15 years old. Severs Disease is generally a self limiting problem, but the pain can persist for several years at varying levels of severity.

Severs disease typically occurs at the bottom back of the heel, and will usually manifest as a child limping of the field of play not putting the heels on the ground.

The cause is related to either a one off traumatic event like jumping out a tree, or a biomechanical problem ie – flat feet, high arches and tight achillies could be the contributing factor. Excess pronation can lead to bow-stringing of the achillies tendon, so that as the heel lifts of the ground the achillies snaps straight causing a tension on the base of the growth plate, aggravating the heel.
Tight calves are a common denominator in most of the cases, as children generally do not do any pre and post warm-up and warm-downs, or alternatively the coaches dont encourage adequate streching routines to encourage flexibility. Perhaps it is assumed that children are naturaally flexible, and they are, unless they play a lot of sport. Increase in muscle strength also reduces flexibility.

The disturbance to the growth plate (epiphyses) causes a temporary retardation of growth, pain on putting the heel down on the ground. The severity can vary, form a mild case where the child is still able to perform and limps off the field after a game, to more severe where it stops them from playing all together. The treatment approach will vary depending on the severity of the problem.
X-rays may pick up on the more severe cases, but are often inconclusive as a diagnostic tool.
History and palpation reveal the classical symptoms the condition presents.

Treatment will vary depending on whom you vist. Drug, anti inflammatories, not the best thing for a child to be honest, are often prescribes, but bear in mind, that this does not deal with the cause and simply masks the pain.

A biomechanical assessment is necessary to establish cause, streching and orthotics may be needed as well as adjustment to sporting habits to allow healing. Severe cases need total rest to allow inflammation to subside.