Sever’s disease is a painful bone disorder that results from inflammation (swelling) of the growth plate in the heel. A growth plate, also called an epiphyseal plate, is an area at the end of a developing bone where cartilage cells change over time into bone cells. As this occurs, the growth plates expand and unite, which is how bones grow.
Sever’s disease is a common cause of heel pain in growing kids, especially those who are physically active. It usually occurs during the growth spurt between ages 8-15. It is rare to get this condition after 15 years of age due to the bones being fully developed at this age. Sever’s disease is similar to Osgood-Schlatter disease, a condition that affects the bones in the knees.
During the growth spurt of early puberty, the heel bone sometimes grows faster than the leg muscles and tendons. This can cause the muscles and tendons to become very tight and overstretched, making the heel less flexible and putting pressure on the growth plate. The Achilles tendon is the strongest tendon that attaches to the growth plate in the heel. Over time, repeated stress on the already tight Achilles tendon damages the growth plate, causing the swelling, tenderness, and pain.
Although Sever’s disease can occur in any child, some of the below can be regarded as risk factors:
- Excessive pronation at the foot –(a foot that rolls in at the ankle too much when walking)causes tightness and twisting of the Achilles tendon, thus increasing its pull on the heel’s growth plate
- High impact sports – such as running, tennis, football or rugby
- Hard surfaces – activities on concrete, 3G football pitches etc
- flat or high arch – which affects the angle of the heel within the foot, causing tightness and shortening of the Achilles tendon
- Limb Lenghth difference (LLD) – (one leg is shorter than the other), which causes the foot on the short leg to bend downward to reach the ground, pulling on the Achilles tendon
- Standing for prolonged periods
- Poorly fitted footwear – too small or too tight, lack of shock absorbing sole
- overweight or obesity – increased pressure on heels and feet in general (*also applies to other joints in the body)
The most obvious sign of Sever’s disease is pain or tenderness in one or both heels, usually at the back. The pain also might extend to the sides and bottom of the heel, ending near the arch of the foot. Most symptoms are worse after periods of activity.
- swelling and redness in the heel
- difficulty walking or playing sports
- discomfort or stiffness in the feet upon first steps after waking
- discomfort when the heel is squeezed on both sides
- altered gait- tip toe walking to reduce pressure on heel
The immediate goal of treatment is pain relief. Because symptoms generally worsen with activity, the main treatment for Sever’s disease is rest, which helps to relieve pressure on the heel bone, decreasing swelling and reducing pain. Other typical treatments are:
- Stretch and strengthen the leg muscles and tendons.
- Ice therapy to the injured heel for 20 minutes two or three times per day, even on days when the pain is not that bad, to help reduce swelling.
- Orthotics insoles – At David Brown Podiatry we can prescribe and fit bespoke insoles to your specific needs. These can be modified to fit any footwear and can be adapted for any sport. We also have a range of off the shelf orthotics for those that have not finished growing yet. David’s experience of professional sport will help in choosing the right orthotics and exercise program to suit your needs.
- Medication (mild painkillers) if severe pain.
- Immobilization of the foot if all other options tried and still getting pain.
Severs disease will usually resolve within 2-12 weeks if fully rested and a specific treatment plan is followed. It can be difficult for a child to fully follow programs and rest during this stage of life. Activity can usually be resumed when the pain has disappeared.
If corrections at the foot are required to address arch disorders, the sooner this is done the better. In most cases this can assist during gait and reduce the risk of other complications that are associated with arch disorders.