Sever’s Disease in Active Children – What is it & Is it Really a Disease?
The name itself sounds horrible and can strike fear into parents when the diagnosis is first mentioned. Fear not! It is not a true “disease” but more simply an irritation of the growth plate of the heel bone (calcaneus) usually occurring in one or both feet in moderately to highly active children between the ages of 8 and 14 years old. Pain is usually felt during and after running activities that can linger into the next day especially out of bed the next morning. When palpating pain is usually felt on the sides of the heel bone.Fear not! Severs Disease is not a true “disease” but more simply an irritation of the growth plate. #performbetter @pogophysio Click To Tweet
The actual medical description for the condition is a calcaneal apophysitis which explains the inflammation of the growth plate of the heel bone. The main cause of inflammation is tension and frictioning of the growth plate due to a tight calf muscle and Achilles tendon. This tightness can be due to rapid growth of the leg bones which causes the calf and Achilles to be “strung out”. Other reasons for tightness include calf and Achilles weakness and/or overuse.
Other major contributing factors include poor gluteal and core strength, flat & high arched feet, poor running and walking technique, rapid weight gain, return to too much activity too soon after a prolonged holiday period, in-correct school and running shoes, hard heel cupped shoes pressing on area of inflammation, flat football boots, hard home flooring and hard sports surfaces including hard football fields.
Treatment usually involves a multi-factorial approach addressing the contributing factors mentioned above. These include soft release of calves and Achilles via massage, EVA heel raises to help reduce symptoms, cushioned heel cups in shoes if symptoms are worse while wearing shoes, calf and core strength exercises, correcting walking and running technique, activity modification i.e. reduction in running while continuing or starting non-impact activities such as swimming and bike riding, possible complete rest from running activities to allow the body to “catch-up” and heal, correcting footwear and the long term prioritising of sports and training load depending if persistence symptoms after return to activity.