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.
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 include Heel Pain. Pain at the back of the heels when walking or running. Possibly a lump at the back of the heel, although this might be minimal. Pain and tenderness at the back of the heels, especially if you press on it, or give it a squeeze from the sides. Tight calf muscles resulting in reduced ankle range of motion.
Children or adolescents who are experiencing pain and discomfort in their feet should be evaluated by a physician. In some cases, no imaging tests are needed to diagnose Sever?s disease. A podiatrist or other healthcare professional may choose to order an x-ray or imaging study, however, to ensure that there is no other cause for the pain, such as a fracture. Sever?s disease will not show any findings on an x-ray because it affects cartilage.
Non Surgical Treatment
See a doctor, who can diagnose the injury and recommend appropriate treatment options. It will be beneficial to rest the affected heel, and to regularly ice the affected area for the first few days. Anti-inflammatory pain medication can reduce pain and swelling, but first check with your doctor. As the pain diminishes a physical therapist can assist with a program of rehabilitation, incorporating stretching and strengthening exercises focused on the calf, shin and hamstring muscles. For a period after the injury has healed the doctor may advise on changes to your training routines that seek to lessen the strain on the heels. Orthotics are often recommended for your shoes in order to correct any biomechanical problems or lend extra support to the heels.
It may take several weeks or months for the pain to completely stop. In most cases severs disease goes away on its own with a little rest and time. However if you ignore the pain and play through it, the condition may get worse and may be more difficult to treat. When the pain is completely gone, you can slowly return to your previous level of activity. With future growth spurts the pain may return therefore keep up with the stretches and follow the advice given.