Sever’s disease is a common cause of heel pain in active children. Sever’s disease, also called calcaneal apophysitis, occurs when the growth plate of the heel is injured by excessive forces during early adolescence. Sever’s disease can be diagnosed based on your history and symptoms. Clinically, your osteopath will perform a “squeeze test” and some other tests to confirm the diagnosis. Some children suffer Sever’s disease even though they do less exercise than others. This indicates that it is not just training volume that is at play. Foot and leg biomechanics are a predisposing factor.
The main factors thought to predispose a child to Sever’s disease include:
• decrease ankle dorsiflexion.
• abnormal hind foot motion eg overpronation or supination.
• tight calf muscles.
• excessive weight-bearing activities eg running.
Sever’s disease is more common in boys. They tend to have later growth spurts and typically get the condition between the ages of 10 and 15. In girls, it usually happens between 8 and 13. Symptoms can include:
• Pain, swelling, or redness in one or both heels
• Tenderness and tightness in the back of the heel that feels worse when
the area is squeezed
• Heel pain that gets worse after running or jumping, and feels better after
rest. The pain may be especially bad at the beginning of a sports season
or when wearing hard, stiff shoes like soccer cleats.
• Trouble walking
• Walking or running with a limp or on tip toes
The good news is that the condition doesn’t cause any long-term foot problems. With osteopathic treatment, the symptoms typically go away after a few months. Your osteopath will identify stiff joints within your foot and ankle complex that they will need to loosen to help you avoid overstress. A sign that you may have a stiff ankle joint can be a limited range of ankle bend during a squat maneuver. Your osteopath will guide you. It’s important to rest. Your child will need to stop or cut down on sports until the pain gets better. When she’s well enough to return to her sport, have her build up her playing time gradually.
Your osteopath may also recommend:
• Ice packs or nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, to relieve the pain
• Stretching and strengthening exercises. In severe cases, your child may need a cast so her heel is forced to rest.
Once your child’s growth spurt ends, and she’s reached full size, her Sever’s disease won’t return. Until then, the condition can happen again if your child stays very active.
Some simple steps can help prevent it. Have your child:
• Wear supportive, shock-absorbing shoes.
• Stretch his calves, heels, and hamstrings.
• Not overdo it. Warn against over-training, and suggest plenty of rest,
especially if he begins to feel pain in her heel.
• Try to avoid lots of running and pounding on hard surfaces.
• If he’s overweight, help him/her lose those extra Kgs, which can increase
pressure on her heels.