Sever's Disease In Children: Causes, Treatment And Prevention

Sever's Disease In Children

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The heel bone is the largest bone in the foot. It is also the most vulnerable one, considering that it can be crushed under the weight of your body in case of an accident or injury.

Heel injuries are common among children who play sports or are otherwise physically active. One such injury is Sever’s apophysitis, which is common among children aged between eight and 14 (1). Here, MomJunction tells you everything about the causes, symptoms, and the best treatment of Sever’s disease in children.

What Is Sever’s Disease?

Also known as calcaneal apophysitis, Sever’s disease is the inflammation of the growth plate in the heel, resulting in severe heel pain. A common cause of heel pain in preteens and adolescents, Sever’s condition is not really a disease and is often mistaken for a growing pain. However, it is an excruciating condition, which can be treated when detected early. The condition does not lead to any long-term complications by itself. But if the heel is abused or overused when the child has Sever’s disease, it could have long-term effects on the foot’s biomechanics.

What Is Sever’s Disease

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If your child limps, walks abnormally, or complains of pain in the heel upon waking up in the mornings, then he needs immediate medical attention.

[ Read: Muscular Dystrophy In Children ]

What Causes Sever’s Disease?

During adolescence, the heel bone is one of the first bones to grow fully. But the heel muscles don’t grow as fast and are not flexible either. Sever’s disease occurs when the heel bone grows faster than the muscle, making the muscles and the ligaments of the heel tight. Pressure on the heel (especially Achilles’ tendon) at such a time due to sports or physical activity can injure the heel, resulting in Sever’s disease (2).

If your child limps, walks abnormally, or complains of pain in the heel upon waking up in the mornings, then he needs immediate medical attention.

Sometimes, even children who do not exercise as much can develop Sever’s disease due to certain predisposed elements. Factors that can contribute to Sever’s disease include:

  • Stiff or tight calf muscles
  • Tightened hamstrings
  • Sports that involve jumping and running
  • Excessive weight-bearing activities such as running
  • Standing for too long, putting the heel under continuous pressure
  • Improper or wrong footwear
  • Excess body weight
  • Abnormal movement of the hind foot
  • Decreased ankle dorsiflexion

If your child participates in athletic activities such as gymnastics, soccer, basketball, ice skating, and ballet that bring them into contact with hardened floors, your child is at a higher risk of Sever’s disease. In the next segment, we help you identify the signs and symptoms of this condition.

Sever’s Disease Symptoms

Sever’s disease may not be a life-threatening condition but can leave your child in a world of pain. Besides the pain, other symptoms of Sever’s disease include:

  • Pain in the heel of one or both legs
  • Difficulty moving, walking, or jumping; the child may not be able to participate in any regular sporting activities
  • Exhaustion
  • Pain or discomfort when the heel is squeezed on both sides
  • Pain or discomfort on waking up or after an extended resting period

[ Read: Joint Pain In Children ]

Watch out for signs such as redness or swelling of the heel, or if the child is limping, walking on toes, or has an unusual walk to avoid putting pressure on the heel. Once you have identified the condition, you must see a doctor for diagnosis.

Sever’s Disease Diagnosis:

Does walking on tiptoes or limping indicate Sever’s disease? Not always. A doctor will look at the child’s medical history and the symptoms before diagnosing Sever’s apophysitis (3). A physical examination is done, and only after a detailed inquiry of the symptoms the cause of heel pain is determined.

The doctor may also perform or recommend the following diagnostic tests and procedures.

  • The doctor would do a squeeze test, which is to press the ankle from both sides to check for pain.
  • He could also make the child stand on tiptoes and check if there is a pain.
  • In some cases, the medical professional may recommend an X-ray, besides the squeeze test, to rule out fractures.

Once the doctor is through with the diagnosis, he will suggest sever’s disease treatment methods.

Treatment Of The Condition:

Considering that Sever’s disease is more of an injury than a disease, its treatment focuses on providing immediate relief from pain and restoring normalcy to the biomechanics of the foot. Treatment of this condition could be simple yet effective (4):

  1. When your child complains of heel pain, ask him or her to avoid any physical activity that might be causing it. Rest is necessary to prevent any further damage to the heel.
  1. Ice packs can help reduce the inflammation or pain in the heel. Keep the leg in an elevated position and wrap a towel around it before applying an ice pack. Do not apply ice directly to the skin.
  1. Stretching exercises may be recommended to stretch and strengthen the heel muscles and tendons. The exercises must be done under the supervision of a physiotherapist or a sports coach trained in physiotherapy. The coach or therapist will first test the heel for flexibility before putting the child on an exercise regimen.

[ Read: Juvenile Idiopathic Arthritis In Children ]

Exercises for rehabilitating of the injured heel include:

  • Active heel stretch in which you extend the leg and pull the foot and the toes up. This stretches the muscles at the back of the leg. Hold the position for eight seconds and repeat slowly.
  • Gastrocnemius stretch is standing exercise. Put the heel of the back leg on the ground and gently push it forward, as shown in the image. Hold the stretch for at least ten seconds. If it is painful, stop immediately.
  • Soleus muscle stretch, where in you continue in the stance taken for the Gastrocnemius stretch, but bend the knee of the back foot and stretch the soleus muscle. Hold for ten seconds and repeat three times.

Remember that these exercises must be done only after consulting the child’s physiotherapist and not before the kid is ready.

  1. Sever’s disease braces and insoles, besides other supportive footwear, can be used to reduce stress on the heel and cope with the pain. The doctor may recommend the use of supportive footwear if the child has any other foot problems that could make Sever’s disease worse.
  1. Pain medication, although not common, can be prescribed by the doctor. Non-steroidal anti-inflammatory drugs such as ibuprofen or acetaminophen (Tylenol) may be used for pain relief.

In rare cases, when the condition is severe, the child may have to wear a cast so that the heel gets the needed rest. With proper care, Sever’s disease usually goes away in just two weeks, although in some cases it may last up to two months. That said, the condition can recur if you do not continue to take care until a certain period. Use of orthotic devices may be necessary to prevent the condition from resurfacing. But, there are other ways to prevent the condition from happening.

[ Read: Stretching Exercises For Kids ]

Can Sever’s Disease Be Prevented?

Sever’s disease usually passes post the growth spurt period. It will not return during adulthood, but it can recur during the growing years if you don’t take proper care, and you can prevent Sever’s disease with a few precautions.

  • Your child should wear proper footwear, such as shock-absorbing shoes with cushioned insoles for supporting the heel, if they participate in sports.
  • Stretch the calf muscles, hamstrings, and heels regularly. However, do not indulge in any strenuous exercises without proper guidance.
  • Avoid over-training or rigorous exercises for any sport. Make sure that the child also gets plenty of rest, especially if the heel begins to ache.
  • Avoid running or pounding feet on hard surfaces.
  • If the child is overweight, help him lose the excess pounds to reduce the stress on the feet.

Sever’s disease cannot be prevented entirely, considering that the contributing factor is the rate of bone and muscle growth in the body. However, a little care during the growing years, especially when the child is physically active and participates in competitive sports, would help the child a lot.

[ Read: Knee Pain In Children ]

Do you have any tips to prevent Sever’s disease? Share them in the comments section below.

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Sagari Gongala

Sagari is a math graduate and studied counseling psychology in postgraduate college, which she uses to understand people better. This skill also helps her write better articles about kids and their behavior. She is meticulous in her research and gives you information that could be the ultimate help you’ll need in times of need. An animal lover, vegan, and coffee addict, Sagari puts her mind and soul into whatever she does. During her free time, you'll find her either rescuing a sick/injured animal with a friend, or glued to her couch watching Sons Of Anarchy on Netflix.
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