As children reach their growth spurt in early puberty, the heel is one of the first body parts to grow to full size. Because children's bones are growing so fast, the muscles or tendons can't keep up
and often become tight. The tight heel tendons can put a lot of stress on the heel, especially if a child is involved in athletics or other weight-bearing activity. Over time, too much pressure on
the heel can injure it and result in Sever's disease, also called calcaneal apophysitis.
Sever?s Disease is thought to be caused by several reasons. Growth spurts. The muscles and tendons become tight due to rapid bone growth. Overuse. Sever?s Disease can also occur in children who are
athletically active and overwork his or her muscles. Some physicians are beginning to caution parents about checking their children?s shoes to make sure they fit well and do not pinch or put undue
pressure on the child?s feet. Pronation can also bring on Sever?s Disease.
The main symptom of sever's disease is pain and tenderness at the back of the heel which is made worse with physical activity. Tenderness will be felt especially if you press in or give the back of
the heel a squeeze from the sides. There may be a lump over the painful area. Another sign is tight calf muscles resulting with reduced range of motion at the ankle. Pain may go away after a period
of rest from sporting activities only to return when the young person goes back to training.
All medical diagnosis should be made by taking a full history, examining the patient then performing investigations. The problem usually occurs in boys who are going through or have just gone through
a growth spurt; one or both heels may be affected. Initially the pain may be intermittent occurring only during or after exercise. As the problem gets worse, pain may be present most of the time.
There may be swelling over the back of the heel and this area is painful if touched or knocked. On examination the patient often has flat feet, very tight legs muscles especially the
Non Surgical Treatment
Massage the calves gently from the knee to the heel, being especially careful around the Achilles? tendon, as this will be extremely tight and tender. During this massage, flex and point the foot
through normal pain-free ranges of motion to increase flexibility while massaging. Massage every other or every third day, making sure your young athlete is not still sore before massaging again. If
you?re unsure how to massage, find someone in your area that uses Graston technique or Active Release Therapy for best results. Stretch your athlete?s calves. This is the most overlooked aspect of
treatment for Sever?s Disease and this needs to be done every day after practice, and when first starting we recommend 2-3 times per day, allowing gravity to pull heel down, never forcing the
stretch. Ice your heels, but don?t just put an ice pack there. Use a cold water soak to fully immerse the foot and calves up to the knee. We recommend using a rubbermaid can found here. Soak for
10-15 minutes. The water does not have to be frigid, just cold. Use cold water from the tap, insert the foot, then add some ice to help bring down the temperature. When your athlete is experiencing
pain, ice every hour, on the hour, for as many times as possible in one day. Make sure the heel/calves are body temperature before beginning again. Support the arches. This is what has been shown in
studies to reduce pain in young athletes with Sever?s Disease. If you miss out on this one, you miss out on relieving your athletes pain.
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