Sever’s Disease
What is it? It is a growth related overuse injury of the foot, specifically the apophysis of the calcaneous (the growth plate where the calf muscles attach). We are not entirely sure what causes this to become symptomatic in some and not in others, however, clinically we commonly see and understand the following:
- It is not a disease as such, rather a growth related injury specific to the apophysis (growth plate of the heel bone where the calf muscles attach). When this growth plate closes, Sever’s Disease, the condition doesn’t bother them.
- Severs Disease is only when the apophysis is ‘hurting/symptomatic’.
- Start of soreness (active Severs Disease) is associated with a relative increase in running, change of direction sports or similar activities.
- Occurs during the period of early puberty with early stages of growth (feet grow first).
- Is made worse with activities such as running, jumping and change of direction sports. The heel feels better with rest.
- Pain is localised to the back of the heel, the apophysis is often tender to touch.
- Pain may change the way they walk and/or run (antalgic gait). They may be walking on tip toes for relative comfort.
This is an X-ray of the heel bone. notice the apparent ‘crack ‘ in the calcaneous (heel bone) where the arrows are pointing, this is the apophysis, cartilage bridges the gap/crack. This is the zone of Sever’s Disease. All feet at this developmental stage will look similar to this, with or without Severs Disease.
What can we do about it?
- EDUCATE your child about it. Use pictures/show pictures of a heel apophysis on an Xray as above. The X-Ray picture gives them a visual. It is MEANT to have a crack here, this is a NORMAL looking growth plate.
- If what they are describing is different from above, you should check in with your family doctor. There should not be swelling, it does NOT typically wake children at night and they should still be able to walk (it may look different to how they normally walk but they should be able to walk).
- We can look at their calf strength and technique of their calf raise. Good technique is important to get them back to their sport and prevent reoccurring Severs.
- We can look at how they move and then teach them how to move better or get stronger as needed. (Squat, Jump, hop, land, balance on one leg).
- We can look at their sport specific skills and teach them how to move better with improved movement patterns specific to their sport.
- Tape. Taping in our clinical practice has been SO helpful for our Severs patients in the short, medium and return to sport phases. (FREE Taping guide DOWNLOAD below)
- Use 4-6mm heel raises in shoes. They should be wearing runners/shoes with a slight graded heel, (Heel is higher than toes). This also takes some pressure off their heel growth plate.
- Teach them self release techniques (massage) for their calves. (roll their calves 2-3 times per day on a foam roller).
- Guide them with a relative off load period, this could be modifying what they are doing at training. (keep in mind when we stop sport activities we are de-loading and this is an overload issue).
- Phase them back into their full activity as their heels get happier.
- Educate them on prevention in the future (this growth plate is open for 3-4 years), yes, in our experience it can be prevented from reoccurring.
For more specific information, you can down load the in-depth PDF version of Sever’s Disease AND coming soon…. our Empowered Parent- ‘Managing Severs Disease mini-course’.