Overview
Sever's Disease is a serious type of 'growing pain' rooted in the fact that the rate of growth of a child's heel bones is slower than that of the ligaments of the leg. The heel bone is one of the first bones in the human body to reach full size, and it is prone to injury because it is not flexible or elastic. As a child goes through growth spurts of the heel bone, the Achilles tendon, which connects the calf muscle to the heel, may be struggling to play catch-up, due to its slower rate of growth. In this scenario, the tendon and leg muscles can become strained, tight and over-stretched. As the child walks, runs or plays, repetitive pressure is placed on the tendon, and the tension can cause damage to the growing heel bone, resulting in pain and inflammation.
Causes
Apart from age, other factors that may contribute to developing Sever?s disease include physical activity, any form of exercise that is weight bearing through the legs or stresses the soft tissue can exacerbate the pain of the disease, External factors, for example, running on hard surfaces or wearing inappropriate shoes during sport Overuse injury, very active children may repeatedly but subtly injure the bones, muscles and tendons of their feet and ankles. In time, the accumulated injuries cause symptoms.
Symptoms
Patients with Severs disease typically experience pain that develops gradually in the back of the heel or Achilles region. In less severe cases, patients may only experience an ache or stiffness in the heel that increases with rest (especially at night or first thing in the morning). This typically occurs following activities which require strong or repetitive contraction of the calf muscles, such as running (especially uphill) or during sports involving running, jumping or hopping. The pain associated with this condition may also warm up with activity in the initial stages of the condition. As the condition progresses, patients may experience symptoms that increase during activity and affect performance. Pain may also increase when performing a calf stretch or heel raise (i.e. rising up onto tip toes). In severe cases, patients may walk with a limp, have difficulty putting their heel down, or be unable to weight bear on the affected leg. Pain may also increase on firmly touching the affected region and occasionally a bony lump may be palpable or visible at the back of the heel. This condition typically presents gradually overtime and can affect either one or both lower limbs.
Diagnosis
Most often, a healthcare professional can diagnose Sever?s disease by taking a careful history and administering a few simple tests during the physical exam. A practitioner may squeeze the heel on either side; when this move produces pain, it may be a sign of Sever?s disease. The practitioner may also ask the child to stand on their tiptoes, because pain that occurs when standing in this position can also be an indication of Sever?s disease.
Non Surgical Treatment
Once diagnosed, there is a list of treatment options available to begin the recovery process. Unfortunately due to the nature of the condition it will often be a reoccurring condition until closure of the growth plates of the heel and elongation of the soft tissue structures. However with appropriate education, correct management of symptoms and prevention strategies, Severs disease can be well managed by the individual and their parents.
Prevention
Properly stretching to maintain flexibility is effective for preventing Sever's disease. Stretches should target the calves, heel cords, and hamstrings. Your child should do the appropriate stretches two or three times a day, holding the stretch for about 20 seconds each time. Ask your child's doctor for specific exercise instructions. Generally, doctors advise stretching both legs, even if the pain is confined to one heel. It's also helpful to strengthen the shin muscles by having your youngster pull his toes in with a rubber exercise band or a piece of tubing and then stretch them forward. Assist your child in doing 15 repetitions of this exercise, three times a day. Having your child wear shoes with good shock absorbers and avoid running on hard surfaces as much as possible should also help prevent the condition.
Sever's Disease is a serious type of 'growing pain' rooted in the fact that the rate of growth of a child's heel bones is slower than that of the ligaments of the leg. The heel bone is one of the first bones in the human body to reach full size, and it is prone to injury because it is not flexible or elastic. As a child goes through growth spurts of the heel bone, the Achilles tendon, which connects the calf muscle to the heel, may be struggling to play catch-up, due to its slower rate of growth. In this scenario, the tendon and leg muscles can become strained, tight and over-stretched. As the child walks, runs or plays, repetitive pressure is placed on the tendon, and the tension can cause damage to the growing heel bone, resulting in pain and inflammation.
Causes
Apart from age, other factors that may contribute to developing Sever?s disease include physical activity, any form of exercise that is weight bearing through the legs or stresses the soft tissue can exacerbate the pain of the disease, External factors, for example, running on hard surfaces or wearing inappropriate shoes during sport Overuse injury, very active children may repeatedly but subtly injure the bones, muscles and tendons of their feet and ankles. In time, the accumulated injuries cause symptoms.
Symptoms
Patients with Severs disease typically experience pain that develops gradually in the back of the heel or Achilles region. In less severe cases, patients may only experience an ache or stiffness in the heel that increases with rest (especially at night or first thing in the morning). This typically occurs following activities which require strong or repetitive contraction of the calf muscles, such as running (especially uphill) or during sports involving running, jumping or hopping. The pain associated with this condition may also warm up with activity in the initial stages of the condition. As the condition progresses, patients may experience symptoms that increase during activity and affect performance. Pain may also increase when performing a calf stretch or heel raise (i.e. rising up onto tip toes). In severe cases, patients may walk with a limp, have difficulty putting their heel down, or be unable to weight bear on the affected leg. Pain may also increase on firmly touching the affected region and occasionally a bony lump may be palpable or visible at the back of the heel. This condition typically presents gradually overtime and can affect either one or both lower limbs.
Diagnosis
Most often, a healthcare professional can diagnose Sever?s disease by taking a careful history and administering a few simple tests during the physical exam. A practitioner may squeeze the heel on either side; when this move produces pain, it may be a sign of Sever?s disease. The practitioner may also ask the child to stand on their tiptoes, because pain that occurs when standing in this position can also be an indication of Sever?s disease.
Non Surgical Treatment
Once diagnosed, there is a list of treatment options available to begin the recovery process. Unfortunately due to the nature of the condition it will often be a reoccurring condition until closure of the growth plates of the heel and elongation of the soft tissue structures. However with appropriate education, correct management of symptoms and prevention strategies, Severs disease can be well managed by the individual and their parents.
Prevention
Properly stretching to maintain flexibility is effective for preventing Sever's disease. Stretches should target the calves, heel cords, and hamstrings. Your child should do the appropriate stretches two or three times a day, holding the stretch for about 20 seconds each time. Ask your child's doctor for specific exercise instructions. Generally, doctors advise stretching both legs, even if the pain is confined to one heel. It's also helpful to strengthen the shin muscles by having your youngster pull his toes in with a rubber exercise band or a piece of tubing and then stretch them forward. Assist your child in doing 15 repetitions of this exercise, three times a day. Having your child wear shoes with good shock absorbers and avoid running on hard surfaces as much as possible should also help prevent the condition.