Severs Disease

What is Sever’s Disease?
Sever’s disease is a common cause of heel pain in active children. Sever’s disease, also called calcaneal apophysitis, occurs when the growth plate of the heel is injured by excessive forces 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 old.
Boys: 10 to 12 years old.

How is Sever’s Disease Diagnosed?
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:

• Decrease ankle dorsiflexion.
• Abnormal hind foot motion eg overpronation or supination.
• Tight calf muscles.
• Excessive weight-bearing activities eg running.

What’s the Treatment for Sever’s Disease?

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 in 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 a pain reducing medication. Check with your doctor.

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

Phase 2: Regain Full Range of Motion

Phase 3: Restore Foot Arch Muscle Control
Your foot arch is dynamically controlled via important foot arch muscles, which 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.

Phase 4: Restore Normal Calf & Leg Muscle Control

Phase 5: Restore Normal Foot Bio mechanics

Phase 6: Improve Your Running and Landing Technique
In order to prevent a recurrence as you return to sport, your physiotherapist will guide you with technique correction and exercises to address these important components of rehabilitation to both prevent a recurrence and improve your sporting performance.

Phase 7: Footwear Analysis

What about Orthotics or Heel Cups?

Occasionally, an orthotic may need to be prescribed for temporary or long-term correction of their foot biomechanics (eg 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.