Sever's disease is a common cause of heel pain, particularly in the young and physically active. During puberty the calcaneus consist of two areas of bone known as ossification centres. These two
areas are divided by an area of cartilage known as the calcaneal apophysitis. See x-ray (right) for two ossification centres of heel. The Achilles tendon attaches the triceps surae (calf muscles) to
the calcaneus (heel bone). As a child grows the calcaneus grow faster than the surrounding soft tissue, which means the Achilles tendon is pulled uncomfortably tight. This increase in tensile load
can cause inflammation and irritation of the calcaneal apophysis (growth plate) which is known as Sever's Disease. The pain is exacerbated by physical activities, especially ones involving running or
jumping. Sever's disease most commonly affects boys aged 12 to 14 years and girls aged 10 to 12 years, which corresponds with the early growth spurts of puberty.
Sever?s disease is directly related to overuse of the bone and tendons in the heel. This can come from playing sports or anything that involves a lot of heel movement. It can be associated with
starting a new sport, or the start of a new season. Children who are going through adolescence are also at risk of getting it because the heel bone grows quicker than the leg. Too much weight bearing
on the heel can also cause it, as can excessive traction since the bones and tendons are still developing. It occurs more commonly in children who over-pronate, and involves both heels in more than
half of patients.
Athletes with Sever?s disease are typically aged 9 to 13 years and participate in running or jumping sports such as soccer, football, basketball, baseball, and gymnastics. The typical complaint is
heel pain that develops slowly and occurs with activity. The pain is usually described like a bruise. There is rarely swelling or visible bruising. The pain is usually worse with running in cleats or
shoes that have limited heel lift, cushion, and arch support. The pain usually goes away with rest and rarely occurs with low-impact sports such as bicycling, skating, or swimming.
Your Podiatrist or Physiotherapist will assist in diagnosing the injury and the extent of the damage. From this, they will develop a management plan which may include rest or activity modification,
soft tissue treatment such as massage and stretching, correction of biomechanics through heel raises or orthoses and the progression through a series of specific strengthening exercises.
Non Surgical Treatment
Orthotics, The orthotics prescribed are made to align the foot in its correct foot posture. This will reduce stress and force at the site of the growth plate of the heel bone. Rest and Ice the heel
20 minutes before and after sporting activity. Calf muscle stretching exercises.
Exercises that help to stretch the calf muscles and hamstrings are effective at treating Sever's disease. An exercise known as foot curling, in which the foot is pointed away from the body, then
curled toward the body in order to help stretch the muscles, has also proven to be very effective at treating Sever's disease. The curling exercise should be done in sets of 10 or 20 repetitions, and
repeated several times throughout the day.