Severs Disease

Severs Disease

Article by John Miller

What is Sever’s Disease?

Sever’s disease is a common cause of active children’s heel pain. Sever’s disease, also called calcaneal apophysitis, occurs when excessive forces injure the growth plate of the heel during early adolescence.

What Causes Sever’s Disease?

Sever’s disease is a common cause of heel pain in physically active growing kids. It usually occurs during the growth spurt of adolescence, the approximately 2-year period in early puberty when kids grow most rapidly. This growth spurt can begin anytime between the ages of 8 to 13 for girls and 10 to 15 for boys.

Peak incidences are:

  • Girls: 8 to 10 years of age.
  • Boys: 10 to 12 years of age.

Sever’s Disease Symptoms

As a parent, you may notice your child limping while walking or running awkwardly. If you ask them to rise onto their tiptoes, their heel pain usually increases. In Sever’s disease, pain can be in one or both heels.

How is Sever’s Disease Diagnosed?

Sever's Disease

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 others. This fact indicates that it is not just a 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 decreased ankle dorsiflexion range.
  • Abnormal hindfoot motion. e.g. overpronation or supination.
  • Tight calf muscles.
  • Excessive weight-bearing activities, e.g. running.

For specific advice regarding your suspected Sever’s Disease, please seek the professional advice of your trusted physiotherapist or doctor.

What’s the Treatment for Sever’s Disease?

Sever’s disease treatment should ease or eliminate pain while restoring standard foot and leg biomechanics.

Phase 1 – Early Injury Protection: Pain Relief & Anti-inflammatory Tips

As with most soft tissue injuries, the initial treatment is Rest, Ice, and Protect.

In the early phase, you’ll most likely be unable to walk pain-free. Our first aim is to provide you with some active rest from pain-provoking activities.

“No Pain. No Gain.” does not apply to Sever’s disease. If it hurts, your child is doing too much exercise. Your child should reduce or cease any activity that causes heel pain.

Ice is a simple and effective modality to reduce your pain and swelling. Please apply for 20-30 minutes each 2 to 4 hours during the initial phase or when you notice that your injury is warm or hot.

Most children can tolerate paracetamol as pain-reducing medication. Check with your doctor.

To support and protect your heels, you may need to wear shock absorbing heel cups or a soft orthoticKinesio foot taping may help to provide pain relief.

Your physiotherapist will guide you. They will utilise a range of pain-relieving techniques, including joint mobilisations for stiff ankle or subtalar joints, massage or electrotherapy, to assist you during this pain-full phase.

Phase 2: Regain Full Range of Motion

Your physiotherapist will identify stiff joints within your foot and ankle complex that they will need to loosen to help you avoid overstress. A sign that you may have a stiff ankle joint can be a limited range of ankle bend during a squat manoeuvre. Your physiotherapist will guide you.

Phase 3: Restore Foot Arch Muscle Control

Your foot arch requires dynamic control. Your essential foot arch muscles could be weak or have poor endurance. These foot muscles have a vital role as the main dynamically stable base for your foot and prevent excessive loading through your plantar fascia.

Any deficiencies will be an essential component of your rehabilitation. Your physiotherapist is an expert in the assessment and correction of your dynamic foot control. They will help you correct your normal foot biomechanics and provide you with foot stabilisation exercises if necessary.

Phase 4: Restore Normal Calf & Leg Muscle Control

You may find it challenging to comprehend, but all of your leg (calf, thigh and hip) muscles play an essential role in controlling your foot arch and its normal function. Your physiotherapist will assess your leg muscle function and provide you with the necessary treatment or exercises as required.

Phase 5: Restore Normal Foot Biomechanics

Your foot biomechanics are the main predisposing factor to Sever’s disease. After a biomechanical assessment, your physiotherapist may recommend an orthotic. This orthotic may be an off the shelf orthotic or a custom made orthotic prescribed by a podiatrist.

Phase 6: Improve Your Running and Landing Technique

To prevent a recurrence as you return to sport, your physiotherapist will guide you with technique correction and exercises to address these critical rehabilitation components to prevent a recurrence and improve your sporting performance.

Your physiotherapist will discuss your goals, time frames and training schedules with you to optimise you for a complete return to sport.

Phase 7: Footwear Analysis

Poorly designed footwear can predispose you to injury. Seek the professional advice of your healthcare practitioner

What about Orthotics or Heel Cups?

Occasionally, a prescribed orthotic may be a temporary or long-term correction of their foot biomechanics (e.g. flat feet or high arches).

During the acute phase of Sever’s disease, a small heel rise or shock-absorbing heel cup placed under the heel pad of your child’s foot may help to ease the symptoms.

Your podiatrist or physiotherapist can assess your child’s arch and guide you in the best management of your child’s condition. We recommend that your child should never go barefooted during the painful stages of Sever’s disease.

What are the Long-Term Consequences of Sever’s Disease?

Poorly treated Sever’s disease can result in a permanent bone deformity at the rear of the heel bone. Long-term, this can cause shoe-fitting difficulties and blisters.

Less obvious long-term effects can include foot arch problems leading to plantar fasciitis or heel spurs and tight calf musculature leading to Achilles tendonitis.

How Can You Prevent Sever’s Disease?

Sever’s disease prevention focuses on maintaining good joint and muscle flexibility in the years leading up to and during their growth spurts (e.g. girls 8 to 10, boys 10 to 12).

Foot arch problems such as flat feet should be addressed after five years of age if they don’t appear to be self-correcting. If you are concerned, please ask your health practitioner. The most crucial factor is the amount of weight-bearing exercise your child is currently performing.

Finally, LISTEN To Your Child!

If your child is suffering heel pain between the ages of 8 to 12, suspect Sever’s disease until proven otherwise. Seek the professional opinion of your chosen foot healthcare practitioner, such as your youth sports injury physiotherapist or a sports podiatrist. They will guide your Severs’ disease management.