Sever?s disease, also referred to as calcaneal apophysitis, is an injury in the growth plate of the lower part of the heel bone where the Achilles tendon attaches to the bone. Sever?s disease is a
common condition affecting children between the ages of 8 and 15 that participate in sports or are particularly active. This condition is believed to be caused by repeated trauma to the heel,
weakening its internal structure. Typically occurring in adolescence, Sever?s disease causes painful inflammation of the growth plate. This condition can affect any child, however there is a higher
probability of its occurrence if the child experiences pronation, has flat or high arches, short leg syndrome and/or is overweight.
Contraction of the calf muscles along with the rapid growth of the leg bone (tibia), decreases ankle motion and increases strain on the heel area. This puts strain on the Achilles tendon. Injury
results from repetitive pulling through the heel bone by the Achilles and the traction forces from the plantar fascia.
Unilateral or bilateral heel pain. Heel pain during physical exercise, especially activities that require running or jumping. Increased pain level after exercise. A tender swelling or bulge on the
heel that is painful on touch. Limping. Calf muscle stiffness first thing in the morning.
Your podiatrist will take a comprehensive medical history and perform a physical examination including a gait analysis. The assessment will include foot posture assessment, joint flexibility (or
range of motion), biomechanical assessment of the foot, ankle and leg, foot and leg muscle strength testing, footwear assessment, school shoes and athletic footwear, gait analysis, to look for
abnormalities in the way the feet move during gait, Pain provocation tests eg calcaneal squeeze test. X-rays are not usually required to diagnose Sever?s disease.
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.
The following exercises are commonly prescribed to patients with Severs disease. You should discuss the suitability of these exercises with your physiotherapist prior to beginning them. Generally,
they should be performed 1 - 3 times daily and only provided they do not cause or increase symptoms. Your physiotherapist can advise when it is appropriate to begin the initial exercises and
eventually progress to the intermediate, advanced and other exercises. As a general rule, addition of exercises or progression to more advanced exercises should take place provided there is no
increase in symptoms. Calf Stretch with Towel. Begin this stretch in long sitting with your leg to be stretched in front of you. Your knee and back should be straight and a towel or rigid band placed
around your foot as demonstrated. Using your foot, ankle and the towel, bring your toes towards your head as far as you can go without pain and provided you feel no more than a mild to moderate
stretch in the back of your calf, Achilles tendon or leg. Hold for 5 seconds and repeat 10 times at a mild to moderate stretch provided the exercise is pain free. Calf Stretch with Towel. Begin this
exercise with a resistance band around your foot and your foot and ankle held up towards your head. Slowly move your foot and ankle down against the resistance band as far as possible and comfortable
without pain, tightening your calf muscle. Very slowly return back to the starting position. Repeat 10 - 20 times provided the exercise is pain free. Once you can perform 20 repetitions consistently
without pain, the exercise can be progressed by gradually increasing the resistance of the band provided there is no increase in symptoms. Bridging. Begin this exercise lying on your back in the
position demonstrated. Slowly lift your bottom pushing through your feet, until your knees, hips and shoulders are in a straight line. Tighten your bottom muscles (gluteals) as you do this. Hold for
2 seconds then slowly lower your bottom back down. Repeat 10 times provided the exercise is pain free.