By Laurence Schubert APAM
Is your child complaining of heel pain? If so, it is likely they are suffering from a condition known as Sever’s Disease or calcaneal apophysitis. Sever’s disease is an inflammatory condition that involves pain in one or both heels, typically seen in adolescents. The calf muscles play a major role in this condition as the site of pain is where these muscles attach, at the base of the heel. In adolescents or children, there may be discrepancies between rate of bone growth and muscle length. When the bone is growing quicker than the muscle is lengthening, this is typically what causes inflammation and pain. This condition has a similar mechanism of injury as Osgood Schlatter's disease.
Why does it occur in children?
As mentioned above, it is due to the rate in which bone grows compared to how quickly the muscle is lengthening. If the muscle has a reduced length, it will produce a repetitive traction force that causes damage at the site of attachment. Furthermore, children’s bones are not completely ossified (hardened) and have certain bony areas that are at risk of injury. These areas include, where a tendon (muscle) attaches to the bone (apophyses).
What are the symptoms?
The most obvious symptom will be pain at the base of the heel. The child will generally have limited ankle range of motion, particularly dorsiflexion (foot towards the shin). This pain will worsen with increased activity, and it is likely that by the end of a the child’s sporting session they will have a significant limp.
Who is likely to have Sever’s Disease?
Males are twice as likely compared to Females, generally between the ages of 7-15 for boys and 5-13 for girls. Sever’s disease will more commonly appear at the start of a sporting season, following a growth spurt from the child.
Can this condition be treated?
Yes it can! Before receiving treatment for Sever’s Disease, it is important to obtain an appropriate diagnosis. A physiotherapist can assess and diagnose the main factors contributing to the pain, it is also important not to miss any more serious conditions that masquerade as Sever’s disease. Part of the treatment may include activity modification, inflammation reduction techniques e.g. RICE, heel lifts, mobilisation, medication, stretching and strengthening of the calf or foot. The earlier you acquire treatment for this condition, the more rapidly the pain will be gone. The longer you wait before seeking treatment, the greater time it will take for the condition to dissipate.