Sever’s Disease, or calcaneal apophysitis is a very common cause of heel pain in active children and the good news is, it can be helped and it will improve.
Apophysitis is the most common syndrome in young athletes and it occurs on both sides in over 50% of cases!
What is Sever’s Disease:
Sever’s Disease is a traction injury where the achilles tendon pulls, pulls and pulls repeatedly on the heel bone. This repeated pulling causes pain and inflammation at the growth plate.
Why does it happen in children?
But why does it only happen in children then? Well when an adult gets repeated stress through their calf and achilles tendon, the heel bone that they attach into are rock solid and so the repeated tugging causes injury to the achilles tendon (achilles tendinopathy – the adult version of sever’s disease) because this is the weaker point.
Where-as in children, their bones are not rock solid, in-fact part of their heel is still cartilage. The heel is made up of two bones, connected together by a cartilage growth plate, so when a child is growing fast, the shin bone gets longer and longer, but the calf muscle and achilles lag behind, causing more and more tension on the heel bone. As you may have guessed, the heel is the weak point so this is what gets injured.
I hope you are with me so far.
This growth plate hardens into bone at 13-15 years of age, which is why sever’s disease only happens in children aged 8 to 15 years old.
Quick points:
- Sever’s disease is caused by repeated pulling of your achilles onto the still hardening heel bone
- Seeing a physio or podiatrist will help
- You do not need to completely stop activity
- Occurs most often in sports that involve running e.g. Track and filed, soccer etc.
The good news: The pain will go away when the growth plate hardens onto bone. BUT that does not mean you need to stop all activity and just wait it out until then. No, there are a lot of things you can do to unload the growth plate – reducing the pull on it, causing less inflammation and allowing it to heal.
How to treat Sever’s disease?
The main 3 things that we want to achieve are:
- Lengthen the calf to stop lessen the pull on the heel
- Increase calf strength and control – lessening the shock and force going through the heel
- Wear appropriate shoes and strap where needed to unload the heel and ensure correct patterns
So here is what you need to do to decrease pain and keep active with sever’s disease:
Calf stretch
There are two main muscles in your calf so you will need to sort out both of them:
1. Straight knee calf stretch
On a step, keep your toes on the step and drop your heel down. Keep your knee bent.
Do not push into pain – hold it when you feel a stretch or slight discomfort.
2. Bent knee calf stretch
The same as above except bend the knee of the same leg – you will feel it stretch in a different part of your calf.
Hold each of them for 30 seconds, three times per day
Calf raises
Holding onto a rail or wall if it helps, raise both heels up and then lower down again, in control.
You do not need to go as high as you can, just as high as is comfortable.
Two sets of fifteen repetitions, do not push into pain.
Proper Shoes:
Shoes have been shown to absorb shock and lessen the force on the heel so are an important aspect.
The ideal shoe will:
- Have good arch support and rear foot control
- Have a moderate to high heel padding (with the heel raised up, this takes the calf off stretch, unloading the pull on the heel!)
- Have around a 10mm heel to toe gradient
I like Asics as they have a good, stable heel support.
Tip: Do not wear thongs/jandals/flip-flops
Strapping:
Arch strapping produces an immediate reduction in heel pain and is great for allowing earlier return to sport and continued activity.(1, 2, 3)
See your local physio for podiatrist for your arch to be strapped and ideally you will be shown how to do this yourself.
Let me know how you go and feel free to follow PhysioPrescription on Twitter or Facebook