Sever’s Disease

Sever’s Disease is a common cause of heel pain especially in physically active young people who are about to or have begun puberty. It is thought that the long calf bones of the leg grow faster than the surrounding muscle and soft tissue, causing the Achilles tendon to pull uncomfortably tight on its attachment onto the Calcaneus (heel bone).

What causes Sever’s Disease:

  • Growth: It usually occurs during the growth spurt of adolescence, the approximately 2-year period in early puberty when kids grow most rapidly
  • Age: The large growth spurt can begin anytime between the ages of 8 to 13 for girls and 10 to 15 for boys.The highest prevalence of Sever’s is in girls aged 8-11 and boys aged 10-13.
  • Anatomy: When the bones grow faster than the muscles, the Achilles tendon that attaches the muscle to the heel gets tight. During growth, the cartilage of the calcaneus is yet to be ossified (turned into bone), and is a potential weak spot. The tight calf muscle and Achilles tendon cause traction on this weak spot, resulting in inflammation and pain.
  • Activity: Sever’s disease is more common in physically active growing kids, and higher volume of activity increases the likelihood of pain.

Symptoms include:

  • Pain at the heel or around the Achilles tendon
  • Heel pain during and after physical exercise, especially activities that require running or jumping
  • Worsening of pain after exercise once cools down, often lasting until the next day
  • A tender swelling or bulge on the heel that is sore to touch
  • Calf muscle stiffness first thing in the morning
  • Limping
  • A tendency to walk on tiptoes (to minimise stretch on muscles and ‘pulling’ on the attachment site)

What to do about it:

Severs disease is a ‘self-limiting’ condition, which means it will get better over time, rarely causing any lasting effects. In the meantime, there are a number of avenues that a physiotherapist can explore in managing the condition. Treatment depends on the severity of the condition, but may include:

  • Relative rest and modified activity: work out what, and how much, activity to undertake is an important job that we can help you undertake. Sometimes choosing between sports or training vs games will make a difference
  • Cold packs: apply ice or cold packs to the back of the heels for around 15 minutes after any physical activity, including walking
  • Footwear: good quality school shoes and runners provide more support to the foot and thus decrease extra load placed on the muscles and joints. Poor footwear can increase symptom intensity and duration
  • Shoe inserts: heel cups that can be inserted into any shoe to raise the heel and take strain off the achilles are a great pain reliever whilst kids deal with the growth spurt and continue to play the sport that they love. We can supply these. Expensive orthotics are often not needed.
  • Medication: pain-relieving medication may help in extreme cases (but should always be combined with other treatment and following consultation with your doctor). Anti-inflammatory creams are also an effective management tool.
  • Time: generally the pain will ease in one to two weeks up top several months, although there may be flare-ups from time to time
  • Correction of any biomechanical issues: a physiotherapist can identify and discuss any biomechanical issues that may contribute to or worsen the condition. Issues such as tight hamstrings, tight hip flexors, weakness around the hips/gluts can contribute and addressing these can help
  • Massage: this is often advised to help relieve the tension on the achilles. This can often be shown to parents and done by parents on the calf muscles with some stretching before bed.

Do you stretch the calf muscles?

It is often not advisable to stretch the calves while symptoms exist as this increases the pull on the attachment.  Once pain settles establishing a good stretching regime will help reduce flare ups when activity increases during seasons. However – stretching surrounding muscles in the lower limb will help as they are often all tight and contribute to the problem

If you feel your child would benefit from chatting with one of our physios to help them relieve their pain, book in for an appointment now.

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