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Severs
Disease
Severs
Disease

INTRODUCTION
Sever's disease or Calcaneal apophysitis
is a condition that affects children between the ages
of 10 and 13 years. It is characterized by pain in one
or both heels with walking. During this phase of life,
growth of the bone is taking place at a faster rate
than the tendons. Hence there is a relative shortening
of the heel-cord compared to the leg bones.
As a result, the tension the heel-cord applies to the
heel bone at its insertion is very great. Moreover,
the heel cord is attached to a portion of the calcaneus
(heel bone) that is still immature, consisting of a
mixture of bone and growing cartilage, called the calcaneal
apophysis, which is prone to injury. Compounding to
this is the fact that all these changes are happening
in a very active child, prone to overuse. The end result
is therefore an overuse syndrome of injury and inflammation
at the heel where the heel cord (Achilles Tendonitis)
inserts into the heel bone (Calcaneal apophysitis).
SYMPTOMS
The typical patient is a child between 10 and 13 years
of age, complaining of pain in one or both heels with
running and walking. The pain is localized to the point
of the heel where the tendo-achilles inserts into the
calcaneus (heel bone), and is tender to deep pressure
at that site. Walking on his toes relieves the pain.
CAUSES
The actual pathology of the condition is one of more
of an overuse syndrome in which the growth plate of
the heel may become slightly displaced, causing pain.
Biopsies of similar conditions have shown changes consistent
with separation of the cartilage.
The cause of Sever's disease is not entirely clear.
It is most likely due to overuse or repeated minor trauma
that happens in a lot of sporting activities - the cartilage
join between the two parts of the bone can not take
all the shear stress of the activities. Some children
seem to be just more prone to it for an unknown reason
- combine this with sport, especially if its on a hard
surface and the risk of getting it increases.
A pronated
foot and tight calf muscles are common contributing
factors.
The condition is very similar to Osgood-Schlatters
Disease which occurs at the knee.
WHAT
YOU SHOULD DO
- Help an overweight child lose weight.
- Encourage your child to exercise moderately, avoiding
extremes.
WHAT
YOU SHOULD NOT DO
- Ignore
the pain. You can not grow out of this disease!
TREATMENT
Treatment revolves around decreasing activity. Usual
treatment has been putting children in a boot in slight
equinus, or a cast with the foot in slight equinus,
thereby decreasing the tension on the heel cord, which
in turn pulls on the growth plate at the heel. As the
pain resolves, children are allowed to go back to full
activities.
- The use of an ice pack after activity for 20mins
is often useful for calcaneal apophysitis - this should
be repeated 2 to 3 times a day.
- If the symptoms are bad enough and are not responding
to these measures, medication to help with inflammation
may be needed. In some cases the lower limb may need
to be put in a cast for 2-6 weeks to give it a good
chance to heal.
LONG
TERM IMPLICATIONS
This condition is self limiting - it will go away when
the two parts of bony growth join together - this is
natural. Unfortunately, Sever's disease can be very
painful and limit sport activity of the child while
waiting for it to go away, so treatment is often advised
to help relieve it. In a few cases of Sever's disease,
the treatment is not successful and these children will
be restricted in their activity levels until the two
growth areas join - usually around the age of 16 years.
There are no known long term complications associated
with Sever's disease.
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If you have any doubts about your child's foot
health visit a chiropodist or podiatrist for a
evaluation.
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