Sever’s Disease (Calcaneal Apophysitis)
Sever’s disease is an inflammatory condition that occurs at the heel bone in children. On the heel bone (calcaneum) there is an area of bone growth called the growth plate or apophysis. It is at this point that the achilles tendon attaches and where the inflammatory process takes place resulting in heel pain.
How does occur?
Sever’s disease usually occurs at times of rapid growth during which the muscles and tendons become tighter as the bones become longer. This results in a traction effect of the Achilles tendon on the growth plate and results in the inflammation and pain.
Predisposing factors that may cause the condition are the wearing of shoes with poor heel support or poor arch support as well as overusing the foot with repetitive heel strikes. The child may also have flat (over pronated feet) as well as tightness in the calf muscles.
Your physiotherapist will be able to diagnose this condition. The child will complain of activity related pain at the heel. There is often swelling and tenderness at the heel where the Achilles tendon inserts. There may also be tightness in the calf as well as predisposing biomechanics of the foot e.g.) flat foot (over pronation). X rays are not usually required except in the case of persistent cases. In this case the x-ray is used to determine if there has been any permanent damage to the growth plate.
Prognosis and treatment
In most cases the condition will settle within 6 to 12 months however in some may cases it may last up to 2 years. The goal of treatment is to return your child to sport as quickly and as safely as possible. The most important part of treatment in the initial stages is modification of activity until the child becomes pain free. In the initial stages physiotherapy will help in reducing the inflammation and pain.
Treatment modalities such as electrotherapy, ice and massage would be used as well as your therapist providing education about activity modification. In the initial stages a heel raise is also used to take the strain of the growth plate. It is also important that your child’s shoe has a good heel and arch support. Your doctor at this time may also have prescribed anti-inflammatory medication. In some cases if the child’s foot biomechanics are predisposing the condition your physiotherapist may referrer you to a podiatrist for the making of custom made arch supports (orthotics).
Once the initial stage has passed your physiotherapist will be able to provide you with a program of stretches. Once the child is pain free, strengthening of the ankle and foot will commence and your physiotherapist will progress these exercises as symptoms permit.
Once symptoms have settled and the child is pain free your physiotherapist will be able to help in a graduated return to sport. It is important to remember that returning to sport to early can lead to exacerbation of symptoms and even permanent damage.