Sever's disease or Calcaneal apophysitis is a condition that affects children between the ages of 10 and 13 years. It is characterized by pain in one or both heels with walking. During this phase of
life, growth of the bone is taking place at a faster rate than the tendons. Hence there is a relative shortening of the heel-cord compared to the leg bones. As a result, the tension the heel-cord
applies to the heel bone at its insertion is very great. Moreover, the heel cord is attached to a portion of the calcaneus (heel bone) that is still immature, consisting of a mixture of bone and
growing cartilage, called the calcaneal apophysis, which is prone to injury. Compounding to this is the fact that all these changes are happening in a very active child, prone to overuse. The end
result is therefore an overuse syndrome of injury and inflammation at the heel where the heel cord (Achilles Tendonitis) inserts into the heel bone (Calcaneal apophysitis).
Sever disease is more common in children who do regular sports or exercise that puts pressure on the heels. Activities such as running and jumping can put stress on the tight muscles and
Often the condition is self limiting; meaning as the growth plate fuses to the rest of the heel bone, the pain will subside. However in some cases the child will have so much discomfort that they
will be unable to walk comfortably if left untreated. Therefore, heel pain in children should always by evaluated by a physician.
Sever?s disease can be diagnosed based on your history and symptoms. Clinically, your physiotherapist will perform a "squeeze test" and some other tests to confirm the diagnosis. Some children suffer
Sever?s disease even though they do less exercise than other. This indicates that it is not just training volume that is at play. Foot and leg biomechanics are a predisposing factor. The main factors
thought to predispose a child to Sever?s disease include a decrease in ankle dorsiflexion, abnormal hind foot motion eg overpronation or supination, tight calf muscles, excessive weight-bearing
activities eg running.
Non Surgical Treatment
stretching exercises can help. It is important that your child performs exercises to stretch the hamstring and calf muscles, and the tendons on the back of the leg. The child should do these
stretches 2 or 3 times a day. Each stretch should be held for about 20 seconds. Both legs should be stretched, even if the pain is only in 1 heel. Your child also needs to do exercises to strengthen
the muscles on the front of the shin. To do this, your child should sit on the floor, keeping his or her hurt leg straight. One end of a bungee cord or piece of rubber tubing is hooked around a table
leg. The other end is hitched around the child's toes. The child then scoots back just far enough to stretch the cord. Next, the child slowly bends the foot toward his or her body. When the child
cannot bend the foot any closer, he or she slowly points the foot in the opposite direction (toward the table). This exercise (15 repetitions of "foot curling") should be done about 3 times. The
child should do this exercise routine a few times daily.
It may take several weeks or months for the pain to completely stop. When the pain is completely gone, your child may slowly return to his or her previous level of activity.