During a growth spurt, your child?s heel bone grows faster than the muscles, tendons, and ligaments in her leg. In fact, the heel is one of your child?s first body parts to reach full adult size.
When the muscles and tendons can?t grow fast enough to keep up, they are stretched too tight. If your child is very active, especially if she plays a sport that involves a lot of running and jumping
on hard surfaces (such as soccer, basketball, or gymnastics), it can put extra strain on her already overstretched tendons. This leads to swelling and pain at the point where the tendons attach to
the growing part of her heel.
There are several theories surrounding the cause of Sever?s disease. These range from a tight Achilles tendon, to micro stress fractures of the heel, to biomechanical mal-alignment, to trauma, to
flat feet, and even to obesity. But the prevailing theory suggests the onset of Sever?s disease occurs when the child's growth plate is at its weakest, while a tightened Achilles tendon pulls
repeatedly on the growth plate, such as during AGS.
The most common symptom of Sever's disease is acute pain felt in the heel when a child engages in physical activity such as walking, jumping or running. Children who are very active athletes are
among the group most susceptible to experiencing Sever's disease because of the extreme stress and tension they place on their growing feet. Improper pronation, the rolling movement of the foot
during walking or running, and obesity are all additional conditions linked to causing Sever's disease.
A doctor or other health professional such as a physiotherapist can diagnose Sever?s disease by asking the young person to describe their symptoms and by conducting a physical examination. In some
instances, an x-ray may be necessary to rule out other causes of heel pain, such as heel fractures. Sever?s disease does not show on an x-ray because the damage is in the cartilage.
Non Surgical Treatment
The following are different treatment options. Rest and modify activity. Limit running and high-impact activity to rest the heel and lessen the pain. Choose one running or jumping sport to play at a
time. Substitute low-impact cross-training activities to maintain cardiovascular fitness. This can include biking, swimming, using a stair-climber or elliptical machine, rowing, or inline skating.
Reduce inflammation. Ice for at least 20 minutes after activity or when pain increases. Nonsteroidal anti-inflammatory drugs (NSAIDs) may also help. Stretch the calf. Increase calf flexibility by
doing calf stretches for 30 to 45 seconds several times per day. Protect the heel. The shoe may need to be modified to provide the proper heel lift or arch support. Select a shoe with good arch
support and heel lift if possible. Try heel lifts or heel cups in sports shoes, especially cleats. Try arch support in cleats if flat feet contribute to the problem.
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