Severs Disease Physical Therapy

Overview

Sever's disease (calcaneal apophysitis) is an inflammatory condition that affects the heel bone (calcaneus). It happens frequently in young athletes between the ages of 10 and 13, causing pain in one or both heels when walking. Tenderness and swelling may also be present. Similar to another overuse condition, Osgood-Schlatter disease, Sever's disease has occasionally been termed Osgood-Schlatter of the heel. In young people, the heel bones are still divided by a layer of cartilage. During the growth years, the bone is growing faster than tendons. This makes it likely that the heel cord will be applying great tension where it inserts into the heel bone. In addition, the heel cord is attached to an immature portion of the heel bone, the calcaneal apophysis. In young athletes, the repetitive stress of running and jumping while playing soccer and basketball may cause an inflammation of the growth center of the heel.

Causes

The condition generally occurs in active children at early adolescence during rapid growth periods as the heel bone can grow faster than the leg muscles causing them to become tight and overstretched. Sever?s disease most often caused by inadequate footwear, playing sport on hard surfaces, calf tightness and biomechanical problems.

Symptoms

The most prominent symptom of Sever's disease is heel pain which is usually aggravated by physical activity such as walking, running or jumping. The pain is localised to the posterior and plantar side of the heel over the calcaneal apophysis. Sometimes, the pain may be so severe that it may cause limping and interfere with physical performance in sports. External appearance of the heel is almost always normal, and signs of local disease such as edema, erythema (redness) are absent. The main diagnostic tool is pain on medial- lateral compression of the calcaneus in the area of growth plate, so called squeeze test. Foot radiographs are usually normal. Therefore the diagnosis of Sever's disease is primarily clinical.

Diagnosis

Your podiatrist will take a comprehensive medical history and perform a physical examination including a gait analysis. The assessment will include foot posture assessment, joint flexibility (or range of motion), biomechanical assessment of the foot, ankle and leg, foot and leg muscle strength testing, footwear assessment, school shoes and athletic footwear, gait analysis, to look for abnormalities in the way the feet move during gait, Pain provocation tests eg calcaneal squeeze test. X-rays are not usually required to diagnose Sever?s disease.

Non Surgical Treatment

Initially, treatment will consist of resting from activity, ice and anti-inflammatory medications to reduce the pain. Your physiotherapist may also use a variety of pain reducing techniques such as soft tissue massage or joint mobilisations. They may recommend taping to unload the area of pain, heel cups or wedge inserts into the bottom of your shoe. Also in the initial phase we may also refer you to podiatry for orthotics and/or further footwear recommendations. It is also ideal in the first instance to start stretching your calf muscles and achilles. This initial phase typically lasts for 1-2 weeks. During this time your physiotherapist will guide you on appropriate levels of activity- they may recommend you rest from impact type activities during this phase, and will guide you on the best program to return to your sport without any further injury.

Exercise

Stretching exercises can help. It is important that your child performs exercises to stretch the hamstring and calf muscles, and the tendons on the back of the leg. The child should do these stretches 2 or 3 times a day. Each stretch should be held for about 20 seconds. Both legs should be stretched, even if the pain is only in 1 heel. Your child also needs to do exercises to strengthen the muscles on the front of the shin. To do this, your child should sit on the floor, keeping his or her hurt leg straight. One end of a bungee cord or piece of rubber tubing is hooked around a table leg. The other end is hitched around the child's toes. The child then scoots back just far enough to stretch the cord. Next, the child slowly bends the foot toward his or her body. When the child cannot bend the foot any closer, he or she slowly points the foot in the opposite direction (toward the table). This exercise (15 repetitions of "foot curling") should be done about 3 times. The child should do this exercise routine a few times daily.

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