Overview
Sever disease, first described in 1912, is a painful inflammation of the calcaneal apophysis. It is classified with the child and adolescent nonarticular osteochondroses. (The other disease in this group is Iselin disease, which is inflammation of the base of the fifth metatarsal.) The etiology of pain in Sever disease is believed to be repetitive trauma to the weaker structure of the apophysis, induced by the pull of the tendo calcaneus (Achilles tendon) on its insertion. This results in a clinical picture of heel pain in a growing active child, which worsens with activity. Sever disease is a self-limited condition; accordingly, no known complication exists from failure to make the correct diagnosis.
Causes
Sever's disease is a common cause of heel pain in physically active growing kids. It usually occurs during the growth spurt of adolescence, the approximately 2-year period in early puberty when kids grow most rapidly. This growth spurt can begin anytime between the ages of 8 to 13 for girls and 10 to 15 for boys. Peak incidences are girls, 8 to 10 years old. Boys, 10 to 12 years old.
Symptoms
Some of the most common signs and symptoms associated with Sever?s disease include. Heel pain or tenderness in one or both heels, usually at the back of the heel. Pain or discomfort upon waking, or when the heel is squeezed. Heel pain that is worse during or following activity. Limping. Heel swelling or redness. Tight calf muscles. Decreased ankle range of motion.
Diagnosis
Your podiatrist will take a comprehensive medical history and perform a physical examination including a gait analysis. The assessment will include foot posture assessment, joint flexibility (or range of motion), biomechanical assessment of the foot, ankle and leg, foot and leg muscle strength testing, footwear assessment, school shoes and athletic footwear, gait analysis, to look for abnormalities in the way the feet move during gait, Pain provocation tests eg calcaneal squeeze test. X-rays are not usually required to diagnose Sever?s disease.
Non Surgical Treatment
Treatment is primarily directed towards reducing the amount of stress to the heel. Often a heel lift, is placed in the shoe to reduce the pull of the Achilles tendon on the apophysis. Gel or cushioned heel cups may also be helpful in reducing micro trauma to the heel. Orthotic control may also be indicated when a pathologic condition exists in the foot that may be contributing to the increased heel stress. Occasionally, it becomes necessary for adequate healing, to rest the area completely. This can be accomplished either by complete elimination of all strenuous activities, or by using a walking cast or crutches. Often simply reducing activity levels is adequate. Your physician will discuss the best treatment plan with you and your child.
Recovery
With proper care, your child should feel better within 2 weeks to 2 months. Your child can start playing sports again only when the heel pain is gone. Your doctor will let you know when physical activity is safe.
Sever disease, first described in 1912, is a painful inflammation of the calcaneal apophysis. It is classified with the child and adolescent nonarticular osteochondroses. (The other disease in this group is Iselin disease, which is inflammation of the base of the fifth metatarsal.) The etiology of pain in Sever disease is believed to be repetitive trauma to the weaker structure of the apophysis, induced by the pull of the tendo calcaneus (Achilles tendon) on its insertion. This results in a clinical picture of heel pain in a growing active child, which worsens with activity. Sever disease is a self-limited condition; accordingly, no known complication exists from failure to make the correct diagnosis.
Causes
Sever's disease is a common cause of heel pain in physically active growing kids. It usually occurs during the growth spurt of adolescence, the approximately 2-year period in early puberty when kids grow most rapidly. This growth spurt can begin anytime between the ages of 8 to 13 for girls and 10 to 15 for boys. Peak incidences are girls, 8 to 10 years old. Boys, 10 to 12 years old.
Symptoms
Some of the most common signs and symptoms associated with Sever?s disease include. Heel pain or tenderness in one or both heels, usually at the back of the heel. Pain or discomfort upon waking, or when the heel is squeezed. Heel pain that is worse during or following activity. Limping. Heel swelling or redness. Tight calf muscles. Decreased ankle range of motion.
Diagnosis
Your podiatrist will take a comprehensive medical history and perform a physical examination including a gait analysis. The assessment will include foot posture assessment, joint flexibility (or range of motion), biomechanical assessment of the foot, ankle and leg, foot and leg muscle strength testing, footwear assessment, school shoes and athletic footwear, gait analysis, to look for abnormalities in the way the feet move during gait, Pain provocation tests eg calcaneal squeeze test. X-rays are not usually required to diagnose Sever?s disease.
Non Surgical Treatment
Treatment is primarily directed towards reducing the amount of stress to the heel. Often a heel lift, is placed in the shoe to reduce the pull of the Achilles tendon on the apophysis. Gel or cushioned heel cups may also be helpful in reducing micro trauma to the heel. Orthotic control may also be indicated when a pathologic condition exists in the foot that may be contributing to the increased heel stress. Occasionally, it becomes necessary for adequate healing, to rest the area completely. This can be accomplished either by complete elimination of all strenuous activities, or by using a walking cast or crutches. Often simply reducing activity levels is adequate. Your physician will discuss the best treatment plan with you and your child.
Recovery
With proper care, your child should feel better within 2 weeks to 2 months. Your child can start playing sports again only when the heel pain is gone. Your doctor will let you know when physical activity is safe.