Category: Severs Disease

Calcaneal Apophysitis Rehab

Overview

One of the more common limitations to children enjoying their youthful energy is Sever?s Disease. Sever?s Disease is a pathology that affects the heels of children in their high growth years (usually around 9-15), and it can be quite painful. It usually occurs due to repetitive trauma or impact at the heel. This means that if your child spends a lot of time running around (in sports, or just with friends) the continuous impact of his or her heel to the ground can cause this! Usually, most children will complain of heel pain specifically when they are active; these are considered milder cases. In more severe cases the pain may never cease, whether the child is active or not.

Causes

The large calf muscles attach to the heel via a large tendon called the Achilles tendon (See image below). The function of this tendon is to transmit forces produced by the calf muscles to the heel bone. In children, the portion of the heel bone into which the Achilles tendon inserts is separated from the bulk of the heel bone by a growth plate. This growth plate enables bone growth to occur. However, it also represents a site of weakness in the bone. Forcible and repeated contraction of the calf muscles can injure the growth plate. This commonly occurs during a period of rapid growth where the muscles and tendons become tighter as the bones grow. This leads to increased pulling of the calf muscles and Achilles tendon on the heel bone and growth plate.

Symptoms

As a parent, you may notice your child limping while walking or running awkwardly. If you ask them to rise onto their tip toes, their heel pain usually increases. Heel pain can be felt in one or both heels in Sever’s disease.

Diagnosis

Physical examination varies depending on the severity and length of involvement. Bilateral involvement is present in approximately 60% of cases. Most patients experience pain with deep palpation at the Achilles insertion and pain when performing active toe raises. Forced dorsiflexion of the ankle also proves uncomfortable and is relieved with passive equinus positioning. Swelling may be present but usually is mild. In long-standing cases, the child may have calcaneal enlargement.

Non Surgical Treatment

See a doctor, who can diagnose the injury and recommend appropriate treatment options. It will be beneficial to rest the affected heel, and to regularly ice the affected area for the first few days. Anti-inflammatory pain medication can reduce pain and swelling, but first check with your doctor. As the pain diminishes a physical therapist can assist with a program of rehabilitation, incorporating stretching and strengthening exercises focused on the calf, shin and hamstring muscles. For a period after the injury has healed the doctor may advise on changes to your training routines that seek to lessen the strain on the heels. Orthotics are often recommended for your shoes in order to correct any biomechanical problems or lend extra support to the heels.

Prevention

Once your child?s growth spurt ends, and she’s reached full size, her Sever?s disease won?t return. Until then, the condition can happen again if your child stays very active. Some simple steps can help prevent it. Have your child. Wear supportive, shock-absorbing shoes. Stretch her calves, heels, and hamstrings. Not overdo it. Warn against over-training, and suggest plenty of rest, especially if she begins to feel pain in her heel. Try to avoid lots of running and pounding on hard surfaces. If she?s overweight, help her lose those extra pounds, which can increase pressure on her heels.

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