Pain in the heel of a child's foot, typically brought on by some form of injury or trauma, is sometimes Sever's Disease. The disease often mimics Achilles tendonitis, an inflammation of the tendon attached to the back of the heel. A tight Achilles tendon may contribute to Sever's Disease by pulling excessively on the growth plate of the heel bone. This condition is most common in younger children and is frequently seen in the active soccer, football or baseball player. Sport shoes with cleats are also known to aggravate the condition. Treatment includes calf muscle stretching exercises, heel cushions in the shoes, and/or anti-inflammatory medications. Consult your physician before taking any medications.
Apart from age, other factors that may contribute to developing Sever?s disease include physical activity, any form of exercise that is weight bearing through the legs or stresses the soft tissue can exacerbate the pain of the disease, External factors, for example, running on hard surfaces or wearing inappropriate shoes during sport Overuse injury, very active children may repeatedly but subtly injure the bones, muscles and tendons of their feet and ankles. In time, the accumulated injuries cause symptoms.
Sever?s is recognized by pain in the back and lower regions of the heel. It usually starts during or immediately following the child's growth spurt, and/or in very active individuals. The child will usually have pain during or following participation in sport, and will often be seen limping off the field or court. Symptoms of Sever's include painful heel, no swelling or warmth, night pain is absent, pain is worse with increased activity, pain which is usually relieved by rest. Children often hobble or limp from the sports field.
A physical exam of the heel will show tenderness over the back of the heel but not in the Achilles tendon or plantar fascia. There may be tightness in the calf muscle, which contributes to tension on the heel. The tendons in the heel get stretched more in patients with flat feet. There is greater impact force on the heels of athletes with a high-arched, rigid foot. The doctor may order an x-ray because x-rays can confirm how mature the growth center is and if there are other sources of heel pain, such as a stress fracture or bone cyst. However, x-rays are not necessary to diagnose Sever?s disease, and it is not possible to make the diagnosis based on the x-ray alone.
Non Surgical Treatment
Treatment aim is to lessen the load on the insertion of the Achilles tendon, along with pain relief if necessary. This can be achieved by modifying/reducing activity levels. Shoe inserts or heel raises. Calf stretches. Avoiding barefoot walking. Strapping or taping the foot to reduce movement. Orthotic therapy if due to biomechanical causes. Other treatment includes icing of the painful area to reduce swelling, pain medication if necessary and immobilisation of the affected limb in severe or long standing cases.
For children with Sever's disease, it is important to habitually perform exercises to stretch the hamstrings, calf muscles, and the tendons on the back of the leg. Stretching should be performed 2-3 times a day. Each stretch should be performed for 20 seconds, and both legs should be stretched, even if the pain is only in one heel. Heel cups or an inner shoe heel lifts are often recommended for patient suffering from Sever's disease. Wearing running shoes with built in heel cups can also decrease the symptoms because they can help soften the impact on the heel when walking, running, or standing.