Sever's disease is an injury to a child's still developing foot structure, specifically an inflammation in the heel's growth plate due to muscle strain and repetitive stress. It is common in young
athletes and children who have problems with pronation. Sever's Disease usually occurs in children age 8, 14 years of age when the child's bones are still in the growth stage and the growth plates
have not become ossified.
Predisposing Hereditary Factors: These are a biomechanical defect that one may be born with, which increases the chances of developing Sever's Disease. Short Achilles Tendon, When the Achilles Tendon
is short from birth, it will exaggerate the tightness of this tendon that occurs during a child's growing years. This makes the pull of the Achilles Tendon on the heel's growth plate more forceful
than normal, causing inflammation and pain, and eventually Sever's Disease. Short Leg Syndrome, When one leg is shorter than the other, the foot on the short leg must plantar flex (the foot and toes
bend down) in order to reach the ground. In this way, the body tries to equalize the length of the legs. In order for the foot to plantar flex, the Achilles Tendon must pull on the heel with greater
force than if the leg was a normal length. Thus the heel on the short leg will be more susceptible to Sever's Disease during the foot's growing years. Pronation. Is a biomechanical defect of the foot
that involves a rolling outward of the foot at the ankle, so that when walking, the inner side of the heel and foot bears more of the body's weight than is normal (click here for more information
about pronation). Pronation thus causes the heel to be tilted or twisted. In order for the Achilles Tendon to attach to the heel, it must twist to reach its normal attachment site. This will shorten
or tighten the Achilles Tendon and increase the force of its pull on the heel's growth plate. This will increase the tightness of the Achilles Tendon during the foot's growing years, and may help to
initiate bouts of Sever's Disease. Flat Arches and High Arches. Both of these biomechanical foot defects effect the pitch, or angle of the heel within the foot. When the heel is not positioned
normally within the foot due to the height of the arch, the Achilles Tendon's attachment to the heel is affected. This may produce a shortening or tightening of the Achilles Tendon, which increases
the force of its pull on the heel's growth plate. During the foot's growing years, abnormal arch height may contribute to the onset of Sever's Disease.
Sever?s disease is a clinical diagnosis based on the youth?s presenting symptoms, rather than on diagnostic tests. While x-rays may be ordered in the process of diagnosing the disease, they are used
primarily to rule out bone fractures or other bone abnormalities, rather than to confirm the disease. Common Characteristics of Sever?s Disease include Posterior inferior heel pain. Pain is usually
absent when waking in the morning. Increased pain with weight bearing, running, or jumping (or activity-related pain). Area often feels stiff or inflexible. Youth may limp at the end of physical
activity. Tenderness at the insertion of the tendons. Limited ankle dorsiflexion range that is secondary to tightness of the Achilles tendon. Activity or sport practices on hard surfaces can also
contribute to pain, as well as poor quality shoes, worn out shoes, or the wrong shoes for the sport. Typically, the pain from this disease gradually resolves with rest.
Sever?s disease can be diagnosed based on the symptoms your child has. Your child?s doctor will conduct a physical examination by squeezing different parts of your child?s foot to see if they cause
any pain. An X-ray may be used to rule out other problems, such as a broken bone or fracture.
Non Surgical Treatment
Orthotic insoles are a common form of treatment for Sever?s disease as they provide support and cushioning to the area which reduces the pressure and stress to the area. Our podiatrist can also show
your child stretches and exercises to help them manage their pain as well offering them advice on their exercise and activity.
After the painful symptoms of Sever's disease have gone away, it is important to continue stretching the heel, particularly before a vigorous exercise, and wearing good supportive shoes fitted with
children's arch supports. This will prevent heel pain recurrence until the child's heel is fully developed and less prone to injury.