What Exactly Is Severs Disease?

Overview

A syndrome of heel pain in skeletally immature individuals. The formal name is: calcaneal apophysitis. The pain is thought to arise from the growth plate (apophysis) and epiphysis. It is thought to be an overuse phenomena. Overloading of the apophysis by both traction (due to Achilles tendon) and compression (sue to weightbearing) have been implicated. Reversible pathologic alterations occur in the apophysis, which cause secondary pain. It is the growth plate and its bone, at the back of the heel bone (calcaneus), whose presence allows for longitudinal growth of calcaneus.

Causes

Sever's disease usually develops as a result of overuse and is common in active children between the ages of 8 to 12. Activities that involve running or jumping can cause undue stress on the calcaneal apophysis. This in turn leads to the development of microscopic damage to the calcaneal apophysis resulting in inflammation and pain. Poor flexibility of the calf muscles and of the Achilles tendon, overpronation (feet rolled in) and inappropriate footwear are some of the other factors that can cause Sever's disease.

Symptoms

Severs causes swelling, pain and tenderness over the back of the heel. Your child may walk with a limp. Initially the pain may be intermittent occurring only during or after exercise. As the problem gets worse, pain may be present most of the time. The swelling increases and is painful when touched or knocked. It commonly affects boys who are having a growth spurt during their pre-teen or teenage years. One or both knees may be affected.

Diagnosis

In Sever's disease, heel pain can be in one or both heels. It usually starts after a child begins a new sports season or a new sport. Your child may walk with a limp. The pain may increase when he or she runs or jumps. He or she may have a tendency to tiptoe. Your child's heel may hurt if you squeeze both sides toward the very back. This is called the squeeze test. Your doctor may also find that your child's heel tendons have become tight.

Non Surgical Treatment

The practitioner should inform the patient and the patient?s parents that this is not a dangerous disorder and that it will resolve spontaneously as the patient matures (16-18 years old). Treatment depends on the severity of the child?s symptoms. The condition is self-limiting, thus the patient?s activity level should be limited only by pain. Treatment is quite varied. Relative Rest/ Modified rest or cessation of sports. Cryotherapy. Stretching Triceps Surae and strengthen extensors. Nighttime dorsiflexion splints (often used for plantar fasciitis, relieve the symptoms and help to maintain flexibility). Plantar fascial stretching. Gentle mobilizations to the subtalar joint and forefoot area. Heel lifts, Orthoses (all types, heel cups, heel foam), padding for shock absorption or strapping of heel to decrease impact shock. Electrical stimulation in the form of Russian stimulation sine wave modulated at 2500 Hz with a 12 second on time and an 8 second off time with a 3 second ramp. Advise to wear supportive shoes. Ultrasound, nonsteroidal anti-inflammatory drugs. Casting (2-4 weeks) or Crutches (sever cases). Corticosteroid injections are not recommended. Ketoprofen Gel as an addition to treatment. Symptoms usually resolve in a few weeks to 2 months after therapy is initiated. In order to prevent calcaneal apophysitis when returning to sports (after successful treatment and full recovery), icing and stretching after activity are most indicated. Respectable opinion and poorly conducted retrospective case series make up the majority of evidence on this condition. The level of evidence for most of what we purport to know about Sever?s disease is at such a level that prospective, well-designed studies are a necessity to allow any confidence in describing this condition and its treatment.

Prevention

Perform a well rounded dynamic warm up before activity. Perform a good static stretching routine after activity. Increase core strength. Perform exercises that emphasize active lengthening of the calf muscles. Use proper footwear. Avoid excessive running or jumping on hard surfaces like concrete by using better surfaces such as asphalt, gymnasium floors or grass.

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