Luba Mcbain

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Overview


Sever's disease, also known as calcaneal apophysitis, is an inflammatory condition of the growth plate of the heel (calcaneus). Sever's disease is seen during periods ofSever's_Disease_x-ray active bone growth, particularly between the ages of 10 and 14 years old. Sever's disease is a self limiting condition, meaning that all cases of Sever's disease will disappear once bone growth is finalized and the growth plate of the heel closes. Skeletal maturity and closure of the growth plate occurs for most children at 15-16 years of age. The onset of Sever's Disease is insidious and found more in boys than girls.


Causes


The heel bone sometimes grows faster than the leg muscles (including the calf muscles) and tendons (including the Achilles tendon) during the early puberty growth spurt. The different growth rate in these structures can cause lower leg muscles and tendons to become overstretched and tight, which makes the heel less flexible and puts excessive pressure on the heel growth plate. The Achilles tendon, the strongest tendon in the body, attaches to the heel growth plate, and repetitive stress on this structure, especially if it?s already tight, can damage the growth plate, leading to tenderness, swelling, and pain. Activities that involve running or jumping, such as soccer, gymnastics, track, and basketball, can place significant stress on a tight Achilles tendon and contribute to the onset of Sever?s disease. Ill-fitting shoes can also contribute to this health problem by failing to provide the right kind of support or by rubbing against the back of heel. The following factors may increase the likelihood of Sever?s disease in kids or young teens. Wearing footwear that is too narrow in the toe box. Leg length inequality. Obesity or carrying excess bodyweight. Excessive foot and ankle pronation.


Symptoms


Sever's Disease is most commonly seen in physically active girls and boys from ages 10 to 15 years old. These are the years when the growth plate is still ""open,"" and has not fused into mature bone. Also, these are the years when the growth plate is most vulnerable to overuse injuries, which are usually caused by sports activities. The most common symptoms of this disease include. Heel pain in one or both heels. Usually seen in physically active children, especially at the beginning of a new sports season. The pain is usually experienced at the back of the heel, and includes the following areas. The back of the heel (that area which rubs against the back of the shoe). The sides of the heel. Actually, this is one of the diagnostic tests for Sever's Disease, squeezing the rear portion of the heel from both sides at the same time will produce pain. It is known as the Squeeze Test.


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


In mild cases, elevating the heel through heel lifts in the shoes and decreasing activity level may be enough to control the pain. In more severe cases, orthotic therapy to help control the motion of the heel, as well as icing, elevating, and aspirin therapy may be required to alleviate the symptoms. In those children who do not respond to either therapy mentioned above, it is sometimes necessary to place the child in a below-knee cast for a period of 4-6 weeks. It is important for both the child and parents to understand that the pain and swelling associated with this disorder should resolve once the growth plate has fused to the primary bone in the heel.


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.