Overview
If you?re a young basketballer/netballer/footballer and have heel pain when playing basketball or sports involving running or jumping, you may have a particular growth pain disorder called Sever?s Disease. It is a condition (not a disease) usually affecting 9-15 year olds that occurs at the back of the heel, where the Achilles tendon attaches to the foot. The Achilles tendon is the tendon connected to the calf muscles. Pulling of the calf muscles results in tension in the Achilles and in adolescents, repeated running/jumping can result in pain and inflammation at the heel, this is called Sever?s Disease.
Causes
Sever’s Disease typically affects boys and girls between 8-15 years of age. Risk factors include. Athletic activity that involves heel contact with hard surfaces, as in gymnastics, track, soccer, basketball, ice skating, ballet and aerobics. The wearing of ill-fitting shoes. Well-made shoes that fit properly are a must for every child. Prolonged periods of standing. If a child complains of heel pain after choir practice, doing dishes, standing in lines or other activities that put pressure on the heel bones, pay attention.
Symptoms
Patients with Severs disease typically experience pain that develops gradually in the back of the heel or Achilles region. In less severe cases, patients may only experience an ache or stiffness in the heel that increases with rest (especially at night or first thing in the morning). This typically occurs following activities which require strong or repetitive contraction of the calf muscles, such as running (especially uphill) or during sports involving running, jumping or hopping. The pain associated with this condition may also warm up with activity in the initial stages of the condition. As the condition progresses, patients may experience symptoms that increase during activity and affect performance. Pain may also increase when performing a calf stretch or heel raise (i.e. rising up onto tip toes). In severe cases, patients may walk with a limp, have difficulty putting their heel down, or be unable to weight bear on the affected leg. Pain may also increase on firmly touching the affected region and occasionally a bony lump may be palpable or visible at the back of the heel. This condition typically presents gradually overtime and can affect either one or both lower limbs.
Diagnosis
It is not difficult for a doctor to diagnose Sever’s disease in a youngster or teenager. A personal history and a physical examination are usually all it takes to determine the cause of heel pain.
Non Surgical Treatment
A doctor, sports therapist or physiotherapist can apply a plaster cast or boot if the child is in severe pain. This may be worn for a few days or even weeks and should give relief of pain for a while. Carry out a full biomechanical assessment. This may help to determine if any foot biomechanics issues are contributing to the condition. Orthotics or insoles can be prescribed to help correct over pronation or other biomechanics issues. Prescribe anti-inflammatory medication such as ibuprofen to reduce pain and inflammation. This will not be prescribed if asthma the child has asthma. In persistent cases X-rays may be taken but this is not usual. A doctor, sports therapist or physiotherapist will NOT give a steroid injection or operate as these are not suitable treatment options. The condition will usually settle within 6 months, although it can persist for longer.
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