Sever?s disease is a painful condition of the heel affecting children, usually at the beginning of the growth spurt in early puberty. It is caused by inflammation at the growth plate at the back of
the heel, adjacent to the Achilles tendon attachment. This is one of the most common causes of heel pain in school-aged children. Physically active children aged between eight and fourteen years old
are most at risk of developing pain from Sever?s disease. It is common among children involved in soccer, little athletics, gymnastics, basketball and netball but can affect children involved in any
running or jumping activity. Boys seem to be more commonly affected than girls.
Sever's Disease is a repetitive strain injury caused by the following. High impact injury activities and sport like netball, football, soccer, hockey, basketball, running, jumping and tennis. Tight
calf muscles. Poor mechanics, structure and function of the foot. Excessive pronation. Rapid growth spurt. The above causes tension, inflammation and pain where the Achilles tendon inserts onto the
calcaneus (Back/bottom surface of the heel bone). It is important that this problem is treated and monitored until the growth plate ossifies in the heel. This could occur between the ages of 14 and
16 years of age. In extreme cases the growth plate can become separated from the calcaneus.
The typical patient is a child between 10 and 13 years of age, complaining of pain in one or both heels with running and walking. The pain is localized to the point of the heel where the
tendo-Achilles inserts into the calcaneus, and is tender to deep pressure at that site. Walking on his toes relieves the pain.
In Sever's disease, heel pain can be in one or both heels. It usually starts after a child begins a new sports season or a new sport. Your child may walk with a limp. The pain may increase when he or
she runs or jumps. He or she may have a tendency to tiptoe. Your child's heel may hurt if you squeeze both sides toward the very back. This is called the squeeze test. Your doctor may also find that
your child's heel tendons have become tight.
Non Surgical Treatment
Treatment for Sever?s disease is mainly supportive, to stop inflammation and reduce pain. The condition will resolve on its own when the growth in the growth plate is complete, but until then,
measures can be taken to resolve pain and discomfort. Applying ice to the painful or swollen areas on the foot may provide some short-term relief from pain and prevent further inflammation. Ice can
be applied for about 20 minutes two or three times a day. Footwear that is too big, too small, or does not provide proper support can exacerbate the symptoms of Sever?s disease. Supportive footwear
is important to prevent discomfort, especially in children who participate in sports and activities that take place on a hard surface (such as pavement or a basketball court). Shoes should also have
adequate padding and not rub against the heel. In some cases, shoes that do not have heels (such as sandals) may be more comfortable to wear while the heel is healing, but care should be taken that
the shoe provides proper support to the rest of the foot. Children with Sever?s disease should avoid going barefoot.Children with flat feet, high arches, or over-pronation may need treatment to
resolve these underlying conditions. In many cases, an orthotic worn inside the shoe can help put the foot into a better alignment and provide relief to the foot or the arch. Children who are
overweight or obese may be counseled to lose weight. Being overweight can contribute to the development of several conditions, including Sever?s disease. Resting the foot and discontinuing sports and
other activities until the pain and stiffness is resolved may be recommended. In extreme cases, a walking boot or a cast might be used to completely immobilize the foot. A physical therapist may
recommend stretching exercises for the muscles in the calf and the Achilles tendon. A stretching routine is usually done several times a day. Stretching these muscles can help improve strength and
decrease the stress on the heel plate. Some physicians may recommend over-the-counter pain relievers such as ibuprofen or acetaminophen. Care must be taken when administering these medications to
children, especially with acetaminophen, as overdoses are possible when using more than one medication containing acetaminophen. Aspirin should never be given to children. The utility of pain
relievers in children must be weighed against their possible side effects. For small variations-less than an inch or so-shoe lifts can help equalize the length of the legs. In cases with more
variation between legs, surgical solutions may be considered. Research indicates that targeted manual therapy techniques performed by a licensed physical therapist can help to reduce pain from
Sever?s Disease and to improve muscle function. When the larger calf muscles and the smaller ankle and foot muscles become tight, this tightness can affect the mechanics of the ankle joint. Manual
therapy includes both joint and muscle release techniques to restore optimal function to the calf, ankle, and foot muscles, and results can generally be achieved within a few months.
The condition is normally self-limiting, and a return to normal activities is usually possible after a period of 2-3 months. In one study, all the patients treated with a physiotherapy programme
(above) improved and could return to their sport of choice after two months of treatment. The condition may recur, although recurrence was uncommon, according to one study.