Severs? disease usually presents with pain in either one or both of a sufferer?s heels. The area can be sore or tender, particularly first thing in the morning or after squeezing. Because the pain is focussed on the heel, an important part of the foot that makes contact with the ground through virtually all movement, sufferers often have to limp to alleviate their discomfort. The pain of Severs? disease is at its worst after any exertion that involves contact between a heel and the ground, particularly strenuous exercise like running or sport. The condition is caused by the wear and tear of structures in the heel, most significantly the heel bone and any attached tendons. Severs? disease is prevalent in young children who are extremely active, particularly as the heel and its attached tendons are still growing in the age group the condition most commonly affects (7-14).
Sever?s disease only occurs during a certain period of pre-adolescence, when the heel bone is going through a rapid growth spurt. In girls, this typically occurs around 8 to 10 years of age, and in boys, between ages 10 and 13. Sever?s disease is more common in active, athletic children. The condition is difficult to prevent completely, but changing the type and amount of physical activity when your child is experiencing pain will help.
Sever's disease usually develops gradually. The pain from Sever's disease is often intermittent and localized to the area where the Achilles tendon attaches to the calcaneus. Swelling may be noted in this area. There can be tenderness on squeezing the calcaneus or pain when trying to stretch the calf muscles. Occasionally there is night pain. As Sever's disease progresses there can be continuous pain.
A physical exam of the heel will show tenderness over the back of the heel but not in the Achilles tendon or plantar fascia. There may be tightness in the calf muscle, which contributes to tension on the heel. The tendons in the heel get stretched more in patients with flat feet. There is greater impact force on the heels of athletes with a high-arched, rigid foot.
Non Surgical Treatment
The aims are to reduce trauma to the heel, allow rest/recovery and prevent recurrence. Most cases are successfully treated using physiotherapy and exercises, eg to stretch the gastrocnemius-soleus complex, to mobilise the ankle mortise, subtalar joint and medial forefoot. Soft orthotics or heel cups. Advice on suitable athletic footwear. Other modes of treatment are in severe cases, temporarily limiting activity such as running and jumping. Ice and non-steroidal anti-inflammatory drugs (NSAIDs), which can reduce pain. In very severe cases, a short period of immobilisation (eg 2-3 weeks in a case in mild equinus position) has been suggested.
Maintain good flexibility through stretching exercises. Avoid excessive running on hard surfaces. Use quality, well-fitting shoes with firm support and a shock-absorbent sole.