Overview
Sever condition is an inflammation of the growth plate of the bone at the back of the heel (apophysitis of the calcaneus). The inflammation of Sever condition is at the point where the Achilles tendon attaches to the back of the heel bone.
Causes
There are several factors which may increase the likelihood of developing this condition. These need to be assessed and corrected with direction from a physiotherapist to ensure an optimal outcome. Some of these factors include inappropriate footwear, calf tightness and/or weakness, joint stiffness (particularly the foot and ankle), poor lower limb biomechanics, inappropriate or excessive training, inadequate recovery periods from training or activity, inappropriate training surfaces, inadequate warm up, poor core stability, a lack of lower limb strength and stability, poor proprioception or balance, rapid growth and age.
Symptoms
This is a condition that affects the cartilage growth plate and the separate island of growing bone on the back of the heel bone. This growth plate is called the physeal plate. The island of growing bone is called the apophysis. It has the insertion attachment of the Achilles tendon, and the attachment of the plantar fascia. This island of bone is under traction from both of these soft tissue tendon and tendon-like attachments.
Diagnosis
Sever?s disease can be diagnosed based on the symptoms your child has. Your child?s doctor will conduct a physical examination by squeezing different parts of your child?s foot to see if they cause any pain. An X-ray may be used to rule out other problems, such as a broken bone or fracture.
Non Surgical Treatment
Treatment depends on the severity of the condition, but may include relative rest and modified activity, a physiotherapist can help work out what, and how much, activity to undertake. Cold packs, apply ice or cold packs to the back of the heels for around 15 minutes after any physical activity, including walking. Shoe inserts, small heel inserts worn inside the shoes can take some of the traction pressure off the Achilles tendons. This will only be required in the short term. Medication, pain-relieving medication may help in extreme cases, but should always be combined with other treatment and following consultation with your doctor). Anti-inflammatory creams are also an effective management tool. Splinting or casting, in severe cases, it may be necessary to immobilise the lower leg using a splint or cast, but this is rare. Time, generally the pain will ease in one to two weeks, although there may be flare-ups from time to time. Correction of any biomechanical issues, a physiotherapist can identify and discuss any biomechanical issues that may cause or worsen the condition. Education on how to self-manage the symptoms and flare-ups of Sever?s disease is an essential part of the treatment.
Recovery
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.
Sever condition is an inflammation of the growth plate of the bone at the back of the heel (apophysitis of the calcaneus). The inflammation of Sever condition is at the point where the Achilles tendon attaches to the back of the heel bone.
Causes
There are several factors which may increase the likelihood of developing this condition. These need to be assessed and corrected with direction from a physiotherapist to ensure an optimal outcome. Some of these factors include inappropriate footwear, calf tightness and/or weakness, joint stiffness (particularly the foot and ankle), poor lower limb biomechanics, inappropriate or excessive training, inadequate recovery periods from training or activity, inappropriate training surfaces, inadequate warm up, poor core stability, a lack of lower limb strength and stability, poor proprioception or balance, rapid growth and age.
Symptoms
This is a condition that affects the cartilage growth plate and the separate island of growing bone on the back of the heel bone. This growth plate is called the physeal plate. The island of growing bone is called the apophysis. It has the insertion attachment of the Achilles tendon, and the attachment of the plantar fascia. This island of bone is under traction from both of these soft tissue tendon and tendon-like attachments.
Diagnosis
Sever?s disease can be diagnosed based on the symptoms your child has. Your child?s doctor will conduct a physical examination by squeezing different parts of your child?s foot to see if they cause any pain. An X-ray may be used to rule out other problems, such as a broken bone or fracture.
Non Surgical Treatment
Treatment depends on the severity of the condition, but may include relative rest and modified activity, a physiotherapist can help work out what, and how much, activity to undertake. Cold packs, apply ice or cold packs to the back of the heels for around 15 minutes after any physical activity, including walking. Shoe inserts, small heel inserts worn inside the shoes can take some of the traction pressure off the Achilles tendons. This will only be required in the short term. Medication, pain-relieving medication may help in extreme cases, but should always be combined with other treatment and following consultation with your doctor). Anti-inflammatory creams are also an effective management tool. Splinting or casting, in severe cases, it may be necessary to immobilise the lower leg using a splint or cast, but this is rare. Time, generally the pain will ease in one to two weeks, although there may be flare-ups from time to time. Correction of any biomechanical issues, a physiotherapist can identify and discuss any biomechanical issues that may cause or worsen the condition. Education on how to self-manage the symptoms and flare-ups of Sever?s disease is an essential part of the treatment.
Recovery
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.