Every year, approximately 30 million children in the U.S participate in various types of organized sports. And without a doubt, sporting activities offer numerous benefits to children and adolescents such as confidence building, as well as helping to build strength and stamina. Sports also provide a positive and constructive outlet for youthful energy. However, children and adolescents are a unique set of athletes. Their bodies are actively growing and they are constantly learning and developing new skills. Therefore, they are highly predisposed to various types of sports-related overuse injuries, arising from training errors, ill-fitting sports gear, as well as muscle weakness and imbalance. Sever’s disease is a result of such overuse injuries.
What is Sever’s Disease?
Also known as apophysitis of the calcaneus, Sever’s disease is a painful inflammation of the heel’s growth rate, which occurs in physically active children, between the ages of 10 and 12 in boys and 8 and 10 in girls. Once children have attained the age of 15 years, it’s highly unlikely they will experience this disease. Sever’s disease is more of a self-limiting condition, which means that it will resolve on its own with time, without long-term harmful effects to the child. Podiatrists can help to manage its symptoms so that the child can continue participating in physical activity.
Causes of Sever’s Disease
Sever’s disease is an overuse injury. It results from exerting too much force on the heel’s growth plate. During a child’s adolescence growth spurt, the heel bone might sometimes grow faster than the tendons and muscles in the leg. And since the tendons and muscles can’t keep up with the heel bone’s growth rate, they will be overstretched and the heel will become less flexible. The tight muscles and tendons will then exert extra pressure on the heel. If the child is physically active or they play a sport that involves plenty of jumping or running on hard surfaces, then such activities and movements will put additional pressure on the already overstretched muscles and tendons, leading to pain and inflammation. Gymnastics, basketball, soccer and running, are some of the physical activities that contribute to this painful heel condition.
Sever’s disease is an age and activity-related condition. As noted above, it’s more common in children who are physically active, especially during their pre-teen phase. Some of the factors that may contribute to this condition include weight and height, the level of physical activity, moving from one sport to another without rest, playing multiple games within a single day or a series of games over a few days, as well as the type of physical activity. Sever’s disease is more prevalent in activities and sports that involve some level of weight-bearing. Also, wearing ill-fitting shoes or shoes with high or flat arches can contribute to this condition. Children who are obese or overweight are also at a high risk of getting Sever’s disease. Also, physically active children with pronated feet are also predisposed to this condition.
Symptoms of Sever’s Disease
Pain and tenderness in the heels are usually the main defining symptom of this condition. The heel pain will then get worse during or after physical activities. Other common symptoms of Sever’s disease include redness of the skin, trouble walking, running or walking on tiptoes or with a limp, stiffness of the feet when walking and swelling of the heel. If your child has complained of heel pain or you have noticed any of these symptoms, then you should take them to a foot specialist.
Diagnosis and Treatment
Doctors will use the symptoms the child has as well as their medical history to diagnose Sever’s disease. The physician might also conduct a physical examination, to determine the extent of the condition. And in some rare cases, medical imaging procedures such as X-rays might be required to help rule out tumors, infections, fractures or other issues that might be contributing to heel pain.
The good news is that Sever’s disease will not lead to any long-term foot issues. In fact, symptoms will disappear on their own after a few months. Reducing pain and inflammation in the heel is usually the first goal of any treatment procedure. Therefore, the doctor will recommend adequate rest for the child. Your child will have to avoid any physical activity that might exert pressure on the heel area. And once the pain has gone away, then they can return to their sporting activities gradually. For instance, instead of going for 3 training sessions in a week, the child can start with a single, light session, to give the feet ample time to adjust. Other available treatment options for Sever’s disease include:
- Ice therapy: Apart from rest, your physician might also recommend the use of ice packs, to minimize inflammation and alleviate the pain. Ice packs should not be placed directly on the child’s skin since they can lead to ice burns. Instead, they should be wrapped in a towel or cloth and then applied to the affected heel for approximately 15 to 20 minutes per session, thrice per day.
- Compression: Wearing compression socks or stockings can also help to alleviate the pain and inflammation.
- Medication: Pain-relieving medication such as ibuprofen and naproxen can also be used to alleviate inflammation and pain. However, the pain-relieving medication should only be used in combination with other treatment methods, after consulting medical or health professionals.
- Shoe inserts: The physician might also recommend orthotics or special shoe inserts, to help reduce pressure and strain on the heel bone. Orthotics are mostly recommended if another condition like low or high arches is aggravating this condition.
- Immobilization: If the Sever’s disease is severe, then the child might be required to wear a foot cast for approximately three months so that the heel will have adequate time to heel.
Monitoring your child’s symptoms as well as their level of physical activity during the treatment phase is vital. Healthcare professionals will use that information to modify the treatment program accordingly. Also, such records can also help physicians to predict the likelihood of future recurrence of Sever’s disease, which helps in preventing it.
After treatment, recovery from this disease will happen without any serious or long-term complications. Your child can resume normal physical activity, once all the symptoms and the pain has gone. Full recovery takes approximately 2 to 8 weeks. However, early intervention might help to prevent the symptoms from escalating while reducing the recovery time. It’s important to note that recurrence of this disease is possible if no steps are taken to address the root of the condition.
Preventing the Recurrence of Sever’s Disease
Stretching properly to maintain flexibility is an effective method for preventing the recurrence of Sever’s disease. The stretching exercises should target the heel cords, hamstrings, and calves. Also, your child shouldn’t be doing high impact activities all the time. Instead, they should alternate high-impact activities with low-impact activities such as biking or swimming. Also, their running or playing surfaces should have some form of cushioning. Avoiding overtraining and ensuring adequate rest can also help to prevent Sever’s disease. Also, wearing proper footwear with ample shock-absorption and heel support qualities is also an effective approach in preventing the recurrence or occurrence of Sever’s disease.
While physical activity is essential for the normal growth of children, it can also lead to overuse injuries such as Sever’s disease – especially if it becomes too excessive or intense. Early recognition and treatment of Sever’s disease, as well as other sports-related overuse injuries, is vital. It will help to alleviate the symptoms as soon as possible while helping your child to return to normal physical activity quickly and safely.