Severs Disease Rehab

Overview

Sever's disease or Calcaneal apophysitis is a condition that affects children between the ages of 10 and 13 years. It is characterized by pain in one or both heels with walking. During this phase of life, growth of the bone is taking place at a faster rate than the tendons. Hence there is a relative shortening of the heel-cord compared to the leg bones. As a result, the tension the heel-cord applies to the heel bone at its insertion is very great. Moreover, the heel cord is attached to a portion of the calcaneus (heel bone) that is still immature, consisting of a mixture of bone and growing cartilage, called the calcaneal apophysis, which is prone to injury. Compounding to this is the fact that all these changes are happening in a very active child, prone to overuse. The end result is therefore an overuse syndrome of injury and inflammation at the heel where the heel cord (Achilles Tendonitis) inserts into the heel bone (Calcaneal apophysitis).

Causes

The heel bone grows faster than the ligaments in the leg. As a result, muscles and tendons can become very tight and overstretched in children who are going through growth spurts. The heel is especially susceptible to injury since the foot is one of the first parts of the body to grow to full size and the heel area is not very flexible. Sever?s disease occurs as a result of repetitive stress on the Achilles tendon. Over time, this constant pressure on the already tight heel cord can damage the growth plate, causing pain and inflammation. Such stress and pressure can result from, Sports that involve running and jumping on hard surfaces (track, basketball and gymnastics). Standing too long, which puts constant pressure on the heel. Poor-fitting shoes that don?t provide enough support or padding for the feet. Overuse or exercising too much can also cause Sever?s disease.

Symptoms

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.

Diagnosis

Sever condition is diagnosed by detecting the characteristic symptoms and signs above in the older children, particularly boys between 8 and 15 years of age. Sometimes X-ray testing can be helpful as it can occasionally demonstrate irregularity of the calcaneus bone at the point where the Achilles tendon attaches.

Non Surgical Treatment

If your child suffers from Sever?s Disease, it is important you take him or her to see your podiatrist, as it can take some time for the condition to completely resolve. Possible treatment options for Sever?s disease may include. Rest from aggravating activities. Ice massage to reduce localised inflammation. Heel lifts placed inside the shoe to reduce the strain on the growth plate. Athletic footwear advice, poor footwear can sometimes be the major contributing factor in the development of Sever?s disease. Orthotic therapy, if your child has an abnormal foot posture that is contributing to the development of Sever?s disease, this will need to be treated with orthotic therapy. Orthotics for Sever?s disease may need to be prescription (custom-made) or non-prescription foot orthotics depending on your child?s foot posture, Exercise program, stretching exercises to improve flexibility of the leg muscles and strengthening exercises to address any foot muscle weakness or imbalance. Avoid barefoot walking, hill running and training on hard surfaces.

Recovery

The condition is normally self-limiting, and a return to normal activities is usually possible after a period of 2-3 months. In one study, all the patients treated with a physiotherapy programme (above) improved and could return to their sport of choice after two months of treatment. The condition may recur, although recurrence was uncommon, according to one study.

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