Does Severs Disease Need To Have Surgical Procedures?

Overview

Sever's disease, or calcaneal apophysitis, is a common cause of heel pain among active children between 10 to 13 years old. This spontaneous heel pain results from injury to the heel bone?s growth plate which is caused by overuse rather than specific injury or trauma. The condition is common among athletic children, particularly those active in soccer, football, and baseball. Treatment is available to reduce pain and discomfort associated with Sever's disease, but the condition usually resolves on its own once feet stop growing.

Causes

The heel bone sometimes grows faster than the leg muscles (including the calf muscles) and tendons (including the Achilles tendon) during the early puberty growth spurt. The different growth rate in these structures can cause lower leg muscles and tendons to become overstretched and tight, which makes the heel less flexible and puts excessive pressure on the heel growth plate. The Achilles tendon, the strongest tendon in the body, attaches to the heel growth plate, and repetitive stress on this structure, especially if it?s already tight, can damage the growth plate, leading to tenderness, swelling, and pain. Activities that involve running or jumping, such as soccer, gymnastics, track, and basketball, can place significant stress on a tight Achilles tendon and contribute to the onset of Sever?s disease. Ill-fitting shoes can also contribute to this health problem by failing to provide the right kind of support or by rubbing against the back of heel. The following factors may increase the likelihood of Sever?s disease in kids or young teens. Wearing footwear that is too narrow in the toe box. Leg length inequality. Obesity or carrying excess bodyweight. Excessive foot and ankle pronation.

Symptoms

The pain is at the heel or around the Achilles tendon. This is felt commonly during exercise, particularly activities involving running or jumping. The back of the heel may also be tender to touch and there may be localised swelling. There may be stiffness in the calf muscles first thing in the morning and you may notice limping or a tendency to tiptoe.

Diagnosis

This can include physical examination and x-ray evaluation. X-rays may show some increased density or sclerosis of the apophysis (island of bone on the back of the heel). This problem may be on one side or bilateral.

Non Surgical Treatment

Occasionally, an orthotic may need to be prescribed for temporary or long-term correction of their foot biomechanics (eg flat feet or high arches). During the acute phase of Sever's disease a small heel rise or shock-absorbing heel cup placed under the heel pad of your child's foot may help to ease the symptoms. Your podiatrist or physiotherapist can assess your child's arch and guide you in the best management of your child's condition. We recommend that your child should never go barefooted during the painful stages of Sever's disease.

Prevention

The old adage, "An once of prevention is worth a pound of cure," is most appropriate when trying to prevent the effects of Sever's Disease. If this condition is not prevented, or treated in its earliest stages, it may cause the child to stop certain sports activities until the growth plate has fused and matured (this usually occurs around the age of 16 years old). Long Term Treatment and Prevention must be directed towards protecting the growth plate at the back of the heel during a child's growing years. Being aware of the following best does this. If the child is very active in sports that require repetitive and exertive activities, then the parents must be vigilant when it comes to the child's gait, watching to see if he or she is limping, walking on their toes, or complaining of heel pain when weight-bearing. These may be "early warning signs" of Sever's Disease. Along with these signs, if your child has any of the Predisposing Hereditary Factors listed above, the chances of Sever's Disease occurring increased.

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