Severs Disease In Children
Overview
A syndrome of heel pain in skeletally immature individuals. The formal name is: calcaneal apophysitis. The pain is thought to arise from the growth plate (apophysis) and epiphysis. It is thought to be an overuse phenomena. Overloading of the apophysis by both traction (due to Achilles tendon) and compression (sue to weightbearing) have been implicated. Reversible pathologic alterations occur in the apophysis, which cause secondary pain. It is the growth plate and its bone, at the back of the heel bone (calcaneus), whose presence allows for longitudinal growth of calcaneus.
Causes
Sever?s is often present at a time of rapid growth in adolescent athletic children. At this time the muscles and tendons become tighter as the bones become larger. Between 8 - 15 years of age is the usual onset of this condition.
Symptoms
A few signs and symptoms point to Sever?s disease, which may affect one or both heels. These include pain at the heel or around the Achilles tendon, Heel pain during physical exercise, especially activities that require running or jumping, worsening of pain after exercise, a tender swelling or bulge on the heel that is sore to touch, calf muscle stiffness first thing in the morning, limping, a tendency to tiptoe.
Diagnosis
Sever?s disease is diagnosed based on a doctor?s physical examination of the lower leg, ankle, and foot. If the diagnosis is in question, the doctor may order x-rays or an MRI to determine if there are other injuries that may be causing the heel pain.
Non Surgical Treatment
A physiotherapist will assess your pain, presentation and biomechanics. They can then treat your sever?s disease with hands on techniques which may include massage, manual therapy and taping. Your physiotherapist can then provide advice on what you can do at home to further progress your treatment, this may include stretching, strengthening and activity modification. In some cases orthotic prescription may be of benefit.
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.
A syndrome of heel pain in skeletally immature individuals. The formal name is: calcaneal apophysitis. The pain is thought to arise from the growth plate (apophysis) and epiphysis. It is thought to be an overuse phenomena. Overloading of the apophysis by both traction (due to Achilles tendon) and compression (sue to weightbearing) have been implicated. Reversible pathologic alterations occur in the apophysis, which cause secondary pain. It is the growth plate and its bone, at the back of the heel bone (calcaneus), whose presence allows for longitudinal growth of calcaneus.
Causes
Sever?s is often present at a time of rapid growth in adolescent athletic children. At this time the muscles and tendons become tighter as the bones become larger. Between 8 - 15 years of age is the usual onset of this condition.
Symptoms
A few signs and symptoms point to Sever?s disease, which may affect one or both heels. These include pain at the heel or around the Achilles tendon, Heel pain during physical exercise, especially activities that require running or jumping, worsening of pain after exercise, a tender swelling or bulge on the heel that is sore to touch, calf muscle stiffness first thing in the morning, limping, a tendency to tiptoe.
Diagnosis
Sever?s disease is diagnosed based on a doctor?s physical examination of the lower leg, ankle, and foot. If the diagnosis is in question, the doctor may order x-rays or an MRI to determine if there are other injuries that may be causing the heel pain.
Non Surgical Treatment
A physiotherapist will assess your pain, presentation and biomechanics. They can then treat your sever?s disease with hands on techniques which may include massage, manual therapy and taping. Your physiotherapist can then provide advice on what you can do at home to further progress your treatment, this may include stretching, strengthening and activity modification. In some cases orthotic prescription may be of benefit.
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.
