What is Sever’s Disease?
Sever’s disease is a condition characterized by pain in the heel. The medical term for the condition is calcaneal apophysitis. The condition goes away after the growth plate fuses into bone. It does not leave behind any long-lasting effects.
What Causes Sever’s Disease & Who Are at Risk from the Condition?
Sever’s disease occurs in children who’ve hit puberty. The growth spurt which boys and girls experience in early puberty is the time when they’re at greatest risk from Sever’s disease. The disease occurs at the growth plate present at the back of the heel. Growth plates, absent in adults, are found in children’s bodies. These are cartilaginous areas present near the ends of bones, where bone growth occurs. The growth area around the heel is where the Achilles tendon is attached to the bone. When muscle growth and tendon development cannot keep up with bone growth, the tendons attached to the heel bone tighten, and repetitive stress from athletic activity can result in Sever’s disease. A child who participates in running, soccer, basketball, gymnastics, and other sporting activities is likelier to experience pain due to this condition. Girls aged 8-13, and boys aged 10-15 are most likely to go through a phase of experiencing Sever’s disease. By the age of 15, the growth plates fuse and the chances of this condition occurring are very low. The condition arises through repetitive stress on the growth plate.
It is worth noting that children with flat feet or excessively arched feet are also susceptible to this condition. Ill-fitting shoes are another cause. Obesity and pronated feet are causative factors for this condition.
What are the Symptoms of Sever’s Disease?
The following symptoms can be present in one or both heels –
- Painful or inflamed heels.
- Inability to place the body’s weight on the heels and thus walking on tiptoes.
- Pain that exacerbates with activities such as running and gymnastics.
- Pain when the heel is squeezed.
The time taken to treat the condition depends on the period for which the symptoms have been present. Therefore, it is important that the child be taken to a doctor as soon as the symptoms are felt. Delay in diagnosis results in a lengthier treatment.
How is Sever’s Disease Diagnosed?
Physicians diagnose Sever’s disease by considering a child’s overall health and through a physical exam. An examination of the foot and heel is conducted to rule out other causes of pain, such as bursitis, bone cysts, and tendonitis. The doctor may ask the child to execute simple movements, and if those movements – walking, running, jumping – cause pain then such symptoms may indicate Sever’s disease. Diagnosing the condition does not usually require an X-ray examination. However, an X-ray can help rule out other probable causes for the symptoms.
How do Doctors Treat Sever’s Disease?
Sever’s disease is treated using a combination of therapy, medicine, and if required, walker boots and leg casts. The prime objective of treatment is to reduce the inflammation and accompanying pain. Simultaneously, the doctors try to reduce the pressure on the growth plate as this is the underlying cause of the discomfort. The child may be advised rest till the pain subsides. By avoiding physical activities and sport, stress on the feet can be mitigated.
The application of ice on the tender portion of the feet can reduce swelling. It is advisable to wrap the ice in cloth and apply up to thrice a day for around 15 minutes – 20 minutes each time. Compression wraps reduce pain and control swelling. The doctor may recommend stretches and exercises for the feet that will develop the tendon and muscles, and bring their growth to the same level as the quickly developing bone. If a child suffering from Sever’s disease has flat or high-arched feet, then arch-supporting slippers, shoes and inserts may be prescribed for relief from stress on the heels. Arch supports are particularly recommended for physically active flat-footed children. Heel cups added to shoes bring relief from pain by absorbing impact and reducing the stress on the tendons and ligaments connected to the heel. If possible, cleats and formal shoes that usually have poor flexibility and cushioning must not be worn during the duration of the treatment.
If such light and regular treatment fails to bring relief then the child may be required to wear a cast for up to 90 days. Over-the-counter pain relievers are prescribed to counter pain and inflammation.
How Long Does the Treatment Process Last?
Usually, the treatment takes up to ninety days, but in some cases, it may have to be prolonged before the swelling and pain subside. The child can then make a gradual and guarded return to physical activity. In most cases, the symptoms of Sever’s disease do not return after the child has reached the age of 15. In order to prevent a relapse during the growth phase, a child must be encouraged to apply ice and give the feet rest after rigorous sporting activity and lie down with the feet elevated to reduce the stress on the heel. A compression bandage can be worn during and after play. This is known as the RICE technique (Rest, Ice, Compression, and Elevation).
Sever’s disease can recur. This happens when the child returns to vigorous sporting activities that stress the feet without giving the ligaments and tendons a chance to fully recover. This may result in permanent damage to the growth plate. A gradual shift to physical activities, preferably those that do not stress the feet, for example, swimming and inline skating, is a good way for the child to stay fit and not get bored. Also, the child’s guardians must ensure that the young one wears proper orthotic footwear and gets into a routine of taking good care of his or her feet, especially after vigorous activity. Sever’s disease can be managed quite effectively to ensure that the pain and inflammation are kept under check. Ice, massage, NSAIDs, and the right footwear will prevent the pain from flaring up. Affected children can easily learn to listen to how their feet respond to different stimuli, such as a hard game of soccer as compared to a walk with their friends, and treat their feet accordingly.