Sever’s disease, also known as calcaneal apophysitis is a condition effecting the growth plate in the heel. It most commonly affects active adolescents between the ages of 8-14 years, before or during their peak growth spurt. The condition often comes on after starting a new sport or when starting a sporting season.
What is it?
Sever’s disease is an inflammation of the growth plate where the Achilles attaches at the back of the heel. During a growth spurt, bone grows faster than muscle and tendons which can lead them to become stretched and tight. Following this, with lots of activity, the tight tendon places excessive force on the growth plate, causing it to become inflamed and irritated. The peak incidence is between 8-10 years old in girls and 10-12 years old in boys. It is important to note that the condition will always settle, generally in 6 to 12 months, but occasionally it can take up to 2 years. Diagnosis can generally be made by your physio with a simple squeeze test in the clinic and other more expensive or invasive tests should not be required.
Symptoms of Sever’s Disease
- Heel pain, especially after running
- Pain and limping when walking
- Pain with raising up onto the balls of the feet
- Swelling and tenderness to touch in the region of the effected heel
The first stage of management aims to settle the pain and inflammation. Rest from or reduction of activity which causes the pain is important, no pain no gain does not apply to Sever’s disease. Ice and anti-inflammatory medication can be very useful in settling inflammation in the growth plate and in making walking and weight bearing more comfortable.
The second stage of management of Sever’s disease looks at addressing poor biomechanics and tight tissue around the growth plate which are contributing to the production of symptoms. Often stretch and massage to the calves and foot can help and provision of heel raises, heel cups and orthotics may help to offload the heel and keep your child active. While poor biomechanics and control are not the cause of the injury, any of these issues may place additional load on the already irritated area, exacerbating the condition. Your physiotherapist can assess the movement and control and provide any corrective rehabilitation exercises as necessary.
The final stage of management of the condition is a gradual return to full sport and activity as the condition settles. Once settled, it is unlikely that you should see a return of symptoms in the area, however a gradual rather than sudden increase in activity is advised.