Diagnosing Severs Disease

Overview

If you?re a young basketballer/netballer/footballer and have heel pain when playing basketball or sports involving running or jumping, you may have a particular growth pain disorder called Sever?s Disease. It is a condition (not a disease) usually affecting 9-15 year olds that occurs at the back of the heel, where the Achilles tendon attaches to the foot. The Achilles tendon is the tendon connected to the calf muscles. Pulling of the calf muscles results in tension in the Achilles and in adolescents, repeated running/jumping can result in pain and inflammation at the heel, this is called Sever?s Disease.

Causes

There are a number of possible causes for a child’s heel pain. Because diagnosis can be challenging, a foot and ankle surgeon is best qualified to determine the underlying cause of the pain and develop an effective treatment plan. Sever’s disease, also known as calcaneal apophysitis, is by far the most common cause of heel pain in children. Other causes of heel pain include tendo-achilles bursitis, other overuse injuries, and fractures.

Symptoms

Symptoms include heel pain related to sports activities and worsen after those sport and exercise activities. However, some children who are not in a sport may also get this if they are physically active. If you notice that your child is ?walking on their toes? this is a sign of possible heel pain. The pain is usually on the back of the heel, the sides of the heel, the bottom of the heel, or a combination of all of these. We typically don’t see swelling with this, however if pressure is applied to the sides of the heel pain may be reported. Sometimes the pain is so bad the child will have to limp, or take a break from sports activity either for a few days or few months.

Diagnosis

Radiography. Most of the time radiographs are not helpful because the calcaneal apophysis is frequently fragmented and dense in normal children. But they can be used to exclude other traumas. Ultrasonography. could show the fragmentation of secondary nucleus of ossification of the calcaneus in severs?s disease. This is a safe diagnostic tool since there is no radiation. This diagnostic tool can also be used to exclude Achilles tendinitis and/or retrocalcaneal bursitis.

Non Surgical Treatment

Initially, treatment will consist of resting from activity, ice and anti-inflammatory medications to reduce the pain. Your physiotherapist may also use a variety of pain reducing techniques such as soft tissue massage or joint mobilisations. They may recommend taping to unload the area of pain, heel cups or wedge inserts into the bottom of your shoe. Also in the initial phase we may also refer you to podiatry for orthotics and/or further footwear recommendations. It is also ideal in the first instance to start stretching your calf muscles and achilles. This initial phase typically lasts for 1-2 weeks. During this time your physiotherapist will guide you on appropriate levels of activity- they may recommend you rest from impact type activities during this phase, and will guide you on the best program to return to your sport without any further injury.