Recently, there has been an increase in children presenting to the clinic with heel pain, so I thought a blog post on the main cause of heel pain in children – Sever’s disease – would be useful.
What is Sever’s disease?
Sever’s disease is described as “a non-inflammatory chronic repetitive injury to the acutely remodelling trabecular metaphyseal bone” (Brukner & Khan, 2012). Essentially, this means damage to the growth plate, or bone very close to the growth plate.
It is the most common cause of heel pain in children, and usually occurs between the ages of 8 and 15 years, from the point the growth plate in the heel starts, to when the growth plate fuses. This renders the condition self-limiting, but it can have a significant affect on an individuals quality of life.
Most children who suffer with it are sport orientated, particularly with regard to running and jumping sports. The level of Sever’s disease in less active children is significantly less, therefore, heel pain in these children is likely to have another cause. It is important to have a full assessment with a suitably qualified and experienced health care professional, who can identify the underlying problem and provide treatment, or refer onwards.
Assessment
When a patient presents to the clinic with any biomechanical or musculoskeletal problem, a full assessment is performed, and this is no different in Sever’s disease. We take a full medical history, including orthopaedic development, and look at joint movements, muscle strength, gait and the forces working upon the lower limbs.
There are a number of simple tests, which enable us to diagnose Sever’s disease, without the use of x-rays, which are particularly sensitive.
Once this assessment is done, we discuss the findings and propose a management plan.
So how is Sever’s disease treated?
Each patient is individual, and because of this each treatment plan is tailored to that individual. However, there are a number of common things, which have been shown to be effective in treating Sever’s disease, and these are used regularly.
Calf muscles stretches – often we find tightness in the calf muscles (the muscles at the back of the leg below the knee), and we provide stretches to help reduce the force from these muscles on to the growth plate.
Orthoses (shoe inserts) – these have been suggested to reduce the forces acting on the bottom of the foot, which again can pull on the growth plate and make symptoms worse. These can help to compress the fat pad around the heel and improve shock absorption. We can also raise the heel slightly to reduce the tension in the calf muscles, again reducing the force on the growth plate.
Footwear advice – often a change in footwear can help with shock absorption in the heel bone, and reduce the forces acting upon the growth plate.
ICE – even though this condition is not inflammatory, the use of ice can provide comfort and ease the pain an individual feels.
Activity modification – it is difficult to get someone sporty to rest completely from their chosen sport, and often this move would be detrimental to them physically, and mentally. Therefore, we advise patients to use a “relative rest” approach. This gets them to listen to their symptoms, and tailor their activity level to find a balance between healing and symptoms.
Calf muscles stretches – often we find tightness in the calf muscles (the muscles at the back of the leg below the knee), and we provide stretches to help reduce the force from these muscles on to the growth plate.
Orthoses (shoe inserts) – these have been suggested to reduce the forces acting on the bottom of the foot, which again can pull on the growth plate and make symptoms worse. These can help to compress the fat pad around the heel and improve shock absorption. We can also raise the heel slightly to reduce the tension in the calf muscles, again reducing the force on the growth plate.
Footwear advice – often a change in footwear can help with shock absorption in the heel bone, and reduce the forces acting upon the growth plate.
ICE – even though this condition is not inflammatory, the use of ice can provide comfort and ease the pain an individual feels.
Activity modification – it is difficult to get someone sporty to rest completely from their chosen sport, and often this move would be detrimental to them physically, and mentally. Therefore, we advise patients to use a “relative rest” approach. This gets them to listen to their symptoms, and tailor their activity level to find a balance between healing and symptoms.
It’s difficult to say how long it will take for Sever’s disease to settle. Most authors on the subject have suggested that a 8 week rehabilitation period is about right. Of course, this is dependant upon the level of pain, the amount of sport a patient undertakes, and how closely the rehabilitation package is followed!
Conclusion
Sever’s disease is common in children and symptoms can be controlled as part of a focused rehabilitation program. Most cases will settle in approximately 8 weeks with a suitable rehabilitation program.
The information in this blog post is not considered to replace a full assessment with a qualified health care professional, so if you have pain, get in touch!
Love Feet, Love Life!
Tel: 01562 51 56 61
Mobile: 077 666 888 29
Email: contact@walkfootcare.co.uk
Mobile: 077 666 888 29
Email: contact@walkfootcare.co.uk
References:
Brukner P & Khan K (2012) Brukner & Khans Clinical Sports Medicine. Fourth Edition. McGraw Hill: Sydney
