Pain in the heel of a child's foot, typically brought on by some form of injury or trauma, is sometimes Sever's Disease. The disease often mimics Achilles tendonitis, an inflammation of the tendon
attached to the back of the heel. A tight Achilles tendon may contribute to Sever's Disease by pulling excessively on the growth plate of the heel bone. This condition is most common in younger
children and is frequently seen in the active soccer, football or baseball player. Sport shoes with cleats are also known to aggravate the condition. Treatment includes calf muscle stretching
exercises, heel cushions in the shoes, and/or anti-inflammatory medications. Consult your physician before taking any medications.
Predisposing Hereditary Factors: These are a biomechanical defect that one may be born with, which increases the chances of developing Sever's Disease. Short Achilles Tendon, When the Achilles Tendon
is short from birth, it will exaggerate the tightness of this tendon that occurs during a child's growing years. This makes the pull of the Achilles Tendon on the heel's growth plate more forceful
than normal, causing inflammation and pain, and eventually Sever's Disease. Short Leg Syndrome, When one leg is shorter than the other, the foot on the short leg must plantar flex (the foot and toes
bend down) in order to reach the ground. In this way, the body tries to equalize the length of the legs. In order for the foot to plantar flex, the Achilles Tendon must pull on the heel with greater
force than if the leg was a normal length. Thus the heel on the short leg will be more susceptible to Sever's Disease during the foot's growing years. Pronation. Is a biomechanical defect of the foot
that involves a rolling outward of the foot at the ankle, so that when walking, the inner side of the heel and foot bears more of the body's weight than is normal (click here for more information
about pronation). Pronation thus causes the heel to be tilted or twisted. In order for the Achilles Tendon to attach to the heel, it must twist to reach its normal attachment site. This will shorten
or tighten the Achilles Tendon and increase the force of its pull on the heel's growth plate. This will increase the tightness of the Achilles Tendon during the foot's growing years, and may help to
initiate bouts of Sever's Disease. Flat Arches and High Arches. Both of these biomechanical foot defects effect the pitch, or angle of the heel within the foot. When the heel is not positioned
normally within the foot due to the height of the arch, the Achilles Tendon's attachment to the heel is affected. This may produce a shortening or tightening of the Achilles Tendon, which increases
the force of its pull on the heel's growth plate. During the foot's growing years, abnormal arch height may contribute to the onset of Sever's Disease.
Children aged between 8 to 13 years of age can experience Sever?s disease with girls being normally younger and boys slightly older. Sever?s disease normally involves the back of the heel bone
becoming painful towards the end of intense or prolonged activity and can remain painful after the activity for a few hours. Severe cases can result in limping and pain that can even remain the next
morning after sport.
Sever?s disease can be diagnosed based on the symptoms your child has. Your child?s doctor will conduct a physical examination by squeezing different parts of your child?s foot to see if they cause
any pain. An X-ray may be used to rule out other problems, such as a broken bone or fracture.
Non Surgical Treatment
The immediate goal of treatment is pain relief. Because symptoms generally worsen with activity, the main treatment for Sever's disease is rest, which helps to relieve pressure on the heel bone,
decreasing swelling and reducing pain. As directed by the doctor, a child should cut down on or avoid all activities that cause pain until all symptoms are gone, especially running barefoot or on
hard surfaces because hard impact on the feet can worsen pain and inflammation. The child might be able to do things that do not put pressure on the heel, such as swimming and biking, but check with
a doctor first.
The surgeon may select one or more of the following options to treat calcaneal apophysitis. Reduce activity. The child needs to reduce or stop any activity that causes pain. Support the heel.
Temporary shoe inserts or custom orthotic devices may provide support for the heel. Medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, help reduce the pain and
inflammation. Physical therapy. Stretching or physical therapy modalities are sometimes used to promote healing of the inflamed issue. Immobilization. In some severe cases of pediatric heel pain, a
cast may be used to promote healing while keeping the foot and ankle totally immobile. Often heel pain in children returns after it has been treated because the heel bone is still growing. Recurrence
of heel pain may be a sign of calcaneal apophysitis, or it may indicate a different problem. If your child has a repeat bout of heel pain, be sure to make an appointment with your foot and ankle