08 Nov 2015 Sever’s Disease
I find working with Children most rewarding. Prior to Podiatry, I studied a Degree in Human Movements with a special interest in Children’s Development. It was during my studies here, I found the area I wanted to work in. Throughout my Podiatry degree at QUT in Brisbane, I found assisting children to reach their full potential by assessing, managing and successfully treating their presenting conditions a thoroughly rewarding experience.
One of the most common conditions I treat is Sever’s Disease. It is a condition that presents in both boys and girls between the ages of 9 and 16. Quite often, many parents have been told that these “growing pains” will pass and in some cases it may, however, in many cases the conditions progresses and can be quite debilitating.
Another name for Sever’s disease is calcaneal apophysitis. ‘Calcaneus’ is your heel bone, ‘apophysis’ is where the tendon joins the heel and ‘itis’ means inflammation. ‘Sever’ is the person who first identified this condition. Quite often parents are alarmed with the word “disease”, believing it to be a life limiting condition, but I’d like to assure you that this is something children will eventually grow out of with the right treatment. There is no evidence to suggest that Sever’s disease causes any long-term problems or complication. It is ‘self limiting’.
So what is Sever’s disease exactly?
A big tendon called the ‘Achilles’ tendon joins the calf muscle at the back of the leg to the heel. It is thought that the heel bone grows faster than the muscle, and the muscle must stretch to accommodate this growth so the muscles and the Achilles tendon that attach the muscle to the heel become really tight. At the same time, the heel bone is soft and weak around its growth center. The tight calf muscle and Achilles tendon cause an injury on the soft heel and the traction causes tiny bits of bone to pull away, causing inflammation.
The pain is further exacerbated if the heel bone is slightly rotated and not positioned straight. Some of the symptoms children may experience include:
- Heel pain in one or both heels;
- Heel pain during physical activity;
- Increase in the severity of pain after exercise;
- Lump or swelling on the heel;
- Heel is tender to touch;
- Tendency to walk tip toed.
In my experience, an assessment of foot posture, gait (walking) and a range of motion assessments including joint range of motion and muscle flexibility need to be undertaken to avoid a prolonged resolution to the condition. Rest and icing can be very beneficial; however, most often if the condition is exacerbated by an abnormal foot posture, orthotic therapy can be used to resolve the condition and also decrease the likelihood of future conditions such as knee and lower back pain.
Currently there are two trains of thought on stretching, and I believe that stretches can be very helpful in certain circumstances, and more detrimental to others. I always judge this need on a case by case basis. In summary, I believe that Sever’s disease although painful, can be resolved successfully with the right assessment techniques and best evidence based practice.