Sever's Disease

Definition

Sever's disease is a musculoskeletal condition that affects children and adolescents as they grow. Also called calcaneal apophysitis, it is a painful inflammation of the growth plate or epiphyseal plate, in the heel bone.

The term ‘disease’ is deceptive, simply put, it is a condition of the heel caused by overuse which affects adolescents during growth spurts in puberty. This is typically between eight and 13 for girls and 10 and 15 for boys. After this time, growth at the heel finishes, the bones at the heel fuse together and the inflammation subsides.

Inflammation can occur when the soft tissues connected to the heel mature more quickly than the bone itself, putting pressure on the bone. Pain is often experienced during adolescent and pre-pubescent growth spurts.

It is more common in active, athletic children and adolescents that play a lot of sport in school and outside, perhaps for a local or county team. Some sports are worse than others for exacerbating symptoms, for example, gymnastics in bare feet is typically bad. Running on tarmac or concrete at length is also likely to worsen the condition, as the heel bone is sensitive to repeated pounding into the pavement. Heel pain can be experienced in one or both feet.

Causes

Strenuous exercise, particularly sprinting, can often aggravate already over-stretched tendons and result in the onset of Sever’s.

In many cases of Sever's the biomechanics of the foot type may increase the chances of developing the disease. These are common foot types that can be causal:

  • a pronated foot type will cause tightness of the Achilles tendon, which increases the stress over the heel bone
  • a high arched foot can also cause tightness over the Achilles tendon
  • leg length discrepancy will cause uneven stress on the heel of the shorter leg
  • Anecdotally, we also see a lot of hypermobile children suffering from Sever’s

 

 

Symptoms

The external appearance of the heel is almost always normal and the primary symptom is a sharp pain that goes up one or both heels, usually at the back. Swelling, tenderness or a tight heel are also painful symptoms that a child may experience. At times the pain can be so debilitating that patients enter the clinic limping or walking on their tip-toes. Sudden knocks to the foot can also be very painful.

Other symptoms may include swelling or redness at the heel, difficulty walking, stiffness upon waking, and discomfort when the heel is squeezed at both sides.

Heel pain that gets worse during and after exercise, particularly jumping or running, can be an indication of Sever’s. There are no long-term consequences of getting the condition at any age.

 

Tests and Diagnosis

A diagnosis is made based on the symptoms. A ‘positive squeeze test’ is used by a GP or clinician as a diagnostic test, by squeezing the heel to bring on the pain. X-rays and imaging do not diagnose Sever's but they may be used to rule out other injuries such as fractures. 

 

Orthotic Treatments

Sever's disease is commonly treated by rest, anti-inflammatory pain relief, ice and elevation. Sometimes the pain will disappear within a few weeks or after a period of rest, but there is the potential for it to recur until the growth plate is fully developed.

When parents come into the clinic, one of the first things we often ask them to do, if their child is particularly active, fills out an activity timetable over a period of weeks to determine how much exercise they are doing and whether it could be considered too much whilst their muscles and skeleton matures.

The long-term prognosis is positive, as the condition is self-limiting i.e. a child will eventually grow out of it during puberty. However, the break from sport can be hard for children who enjoy playing regularly for a team at a competitive level. For cases like this, bespoke orthotic insoles can offer a good solution.

Foot orthotics can help all foot types with a predisposition to Sever’s, by normalising the foot posture, particularly the hindfoot and reducing stress at the heel caused by a tightened Achilles heel.

Heel lift orthotics raise the heel inside the shoe and can prevent the Achilles from pulling hard on the growth plate. For other patients, more padding or shock-absorbing material may be appropriate and added to their insoles. As they are bespoke, they will vary from patient to patient.

FAQs:

We have the following facilities and amenities at our Kingston Upon Thames location:

  • Free parking
  • Wheelchair ramp
  • Disabled toilet
  • Baby changing facilities

We also have the Gait Laboratory for orthotics patients and Onsite Manufacturing for speedy turnarounds and adjustments whilst you wait.

We have the following facilities and amenities at our Cambridge location:

  • Free parking directly outside the clinic
  • Large Waiting Room
  • No Toys (Due to Health & Safety Requirements of the clinic)
  • Baby changing space (In clinic room)

For more information about The Beechwood Complementary Medical Practice, please visit The Beechwood Practice.

We have the following facilities and amenities at our Bristol location:

  • Free parking directly outside the clinic
  • Large Waiting Room
  • Free tea, coffee and water
  • No Toys (Due to Health & Safety Requirements of the clinic)
  • Baby changing space (In clinic room)
  • Fully wheelchair accessible
  • Short walk to Clifton Village centre for shops, restaurants & cafes

For more information, visit Litfield House Medical Centre.

LOC’s clinic is based in the University of Salford’s Podiatry Department and provides treatments for orthotics, scoliosis, pectus deformities, positional plagiocephaly and club foot.

It is also the base for LOC’s northern OSKAR clinic which is run by Sam Walmsley, clinical director of LOC, in conjunction with Elaine Owen MBE MSc SRP MCSP.

Due to COVID-19, we have had to temporarily close the Salford clinic and are operating out of another clinic in Bolton. 

508 Blackburn Rd,

Astley Bridge,

Bolton

BL1 8NW

 

For more information, please visit The Good Health Centre 

An insole is a contoured orthotic device which alters the characteristics and biomechanics of the foot and ankle area. Biomechanics are concerned with mechanical laws and how they affect the living body, especially the musculoskeletal system.

They are removable devices, often made from plastic, that are designed to fit inside a shoe to provide additional support for your feet. As well as offering shock absorption, an insole can help distribute the weight of your body more effectively across the foot and can be made bespoke to cover a range of biomechanical conditions.

If you have symptoms in your feet, ankles, hips or your lower back that are intermittent or were not there to start with in early life, and have started to cause you pain over a period of time, bespoke orthotic insoles could be an excellent option.

If you have already tried rest, icing, compression and elevation and your feet have not recovered, we recommend a biomechanical assessment to consider the possibility of insoles. They are a non-invasive approach to treatment and in many cases, are a great option for symptoms that are not severe enough to warrant surgical intervention. Alternatively, they can be considered as an option prior to surgery.

We will send patients away when an insole is not appropriate, if a patient is suffering with iliotibial band syndrome for example, the problem can be helped with physiotherapy and a stretching programme. That’s what our biomechanical assessment is all about; determining whether there would be any benefit from altering the alignment of your feet.

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