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May162015

02:08:43 pm

Addressing Severs Disease

Overview


Sever's Disease, otherwise known as calcaneal apophysitis is an inflammation of the growth plate in the heel of growing children, typically adolescents. The condition presents as pain in the heel and is caused by repetitive stress to the heel and is thus particularly common in active children. It usually resolves once the bone has completed growth or activity is lessened.


Causes


Sever's disease can result from standing too long, which puts constant pressure on the heel. Poor-fitting shoes can contribute to the condition by not providing enough support or padding for the feet or by rubbing against the back of the heel. Although Sever's disease can occur in any child, these conditions increase the chances of it happening. Pronated foot (a foot that rolls in at the ankle when walking), which causes tightness and twisting of the Achilles tendon, thus increasing its pull on the heel's growth plate. Flat or high arch, which affects the angle of the heel within the foot, causing tightness and shortening of the Achilles tendon. Short leg syndrome (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. Overweight or obesity, which puts weight-related pressure on the growth plate.


Symptoms


If your child is suffering from this disease they will be experiencing pain and tenderness in the back of their foot. This soreness can also extend to the sides of the feet. Other sure signs of this disorder include swelling and sensitivity to touch. Because of the amount of discomfort, your child may find it difficult to walk or run. Pay attention to the way your child is walking. If you notice unusual posture or abnormal gait they may be avoiding placing pressure on the heel. These symptoms typically become apparent during activity and exercise or directly following it. If your child is indicating pain in their heel, schedule an appointment with us today.


Diagnosis


Sever?s disease can be diagnosed based on your history and symptoms. Clinically, your physiotherapist will perform a "squeeze test" and some other tests to confirm the diagnosis. Some children suffer Sever?s disease even though they do less exercise than other. This indicates that it is not just training volume that is at play. Foot and leg biomechanics are a predisposing factor. The main factors thought to predispose a child to Sever?s disease include a decrease in ankle dorsiflexion, abnormal hind foot motion eg overpronation or supination, tight calf muscles, excessive weight-bearing activities eg running.


Non Surgical Treatment


Your child's healthcare provider will ask about your child's symptoms and examine your child's feet and heels. Any of the following may be done to treat your child's pain. NSAIDs help decrease swelling and pain or fever. This medicine is available with or without a doctor's order. NSAIDs can cause stomach bleeding or kidney problems in certain people. If your child takes blood thinner medicine, always ask if NSAIDs are safe for him. Always read the medicine label and follow directions. Do not give these medicines to children under 6 months of age without direction from your child's doctor. Acetaminophen decreases pain and fever. It is available without a doctor's order. Ask how much your child should take and how often to take it. Follow directions. Acetaminophen can cause liver damage if not taken correctly. Rest will decrease swelling, and keep the heel pain from getting worse. Your child may need to decrease his regular training or exercise. He may need to completely stop running and doing other activities that put pressure on his heel until his heel pain is gone. Ask your child's healthcare provider about activities that do not put pressure on the heel. Ice should be applied on your child's heel for 15 to 20 minutes every hour or as directed. Use an ice pack, or put crushed ice in a plastic bag. Cover it with a towel. Ice helps prevent tissue damage and decreases swelling and pain. Stretching and strengthening exercises may be recommended. A healthcare provider may teach your child exercises to stretch the hamstring and calf muscles and the tendons on the back of the leg. Other exercises will help strengthen the muscles on the front of the lower leg. Your child may be told to stop exercising if he feels any pain. Shoe inserts may be needed. Your child's healthcare provider may give you heel pads or cups for your child's shoes to decrease pressure on the heel bone. You may also be given shoe inserts with firm arch support and a heel lift. Make sure your child wears good quality shoes with padded soles. Your child should not walk barefoot. An elastic wrap or compression stocking may be needed. Your child's healthcare provider may want your child to use a wrap or stocking to help decrease swelling and pain. Ask how to apply the wrap or stocking.

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