Sever’s Disease: Brisbane Solutions for your Child ‘s Foot Pain and Heel Pain.
Everything you need to know about Sever’s disease and heel pain in children is here. Read on to learn who get it, why it happens and how to treat it.
If the pain is occurring in an adult, see our Plantar Fasciitis section.
What is Sever’s Disease?
Sever’s Disease is a painful condition that affects the heel bone of children during adolescence. It is most common between the ages of 10 to 14 years. It is more common in boys than girls and is most common in active kids. The cause of Sever’s Disease is a mechanical problem discussed below.
Typically, the child will limp while playing sport. The pain often is present the next morning when getting out of bed. While any weight bearing activity can bring on Sever’s Disease, soccer and football seem to be most common.
Fortunately, the majority of sufferers respond very well to treatment. Most kids can return to sport a couple of weeks after receiving proper treatment. If your child is troubled by heel pain, allow us to help you with prompt, proven treatment.
Why does Sever’s disease occur ?
Children’s bones have a cartilage disc called a growth plate. This sits in one or both ends of a bone, but not inside a joint. These areas fuse or turn into bone in the feet at about 16 years of age.
In a perfectly functioning foot the heel strikes the ground in a particular way. The cartilage that is sandwiched between two ends of the heel bone is compressed evenly across the whole surface. Sever’s Disease is most commonly found in kids where the foot rolls in excessively or pronates. The bone is then compressed on an angle that causes a shearing stress on the cartilage plate.
This shearing force causes the growth plate to become inflamed, painful and to swell within its very tight space. This swelling can create a serious problem. The end piece of bone is supplied with blood vessels from the main body of the bone and these pass through the cartilage plate. If the cartilage swells too much, it can close off these vessels and result in avascular necrosis. This is a Latin term meaning tissue death from lack of blood supply.
As this is a growing child, the bone will repair without too much long term effect. However, it will be painful for an extended period usually about two years. Obviously, this is to be avoided as no active child wants to suffer pain nor be forced to sit out of sport for years.
Fortunately, avascular necrosis will almost always have a long lead up time. It is very unlikely that bone will die without several months of increasing pain giving warning of what is to come.
How do you treat Sever’s Disease ?
Treatment often involves using orthotic devices and avoiding specific types of shoes. It is also very important to assess the length of the calf muscles. Short calf muscles are a big contributor to Sever’s Disease and go hand in hand with pronated feet. Incorrect or excessive stretching can make the problem worse, so we will show you how to effectively stretch during our assessment. We may also use a heel lift to help until the stretching program has an effect. Happily, treatment with the podiatrist is very likely to resolve the problem very quickly.
Should I get an X-ray for Sever’s disease?
Generally, the answer is no. A diagnosis of Sever’s Disease is usually strongly based on the history of the problem and some simple tests we will perform when we assess your child. Added to this, the early signs of Sever’s Disease are not visible on X Ray. The changes that can be seen later occur with actual bone tissue death. We are always aiming to begin treatment well before there is permanent tissue damage and therefore, always hope to resolve this problem before an X-ray would be useful.
Also, in general, like any health professional, we will only take an x-ray if the findings are likely to affect the treatment plan. If we are confident that your child has Sever’s disease, we will lay out a treatment plan to address it. Taking an x-ray is unlikely to confirm the diagnosis and is much more likely to be inconclusive. This step can be unnecessarily confusing for parents as it seems to ‘rule out’ what we think is the problem. It also can be a waste of time where treatment could be commenced and the condition resolved. Added to this is the general rule that we will avoid exposing a child (or indeed an adult) to ionising radiation, even if it is a very small dose, without a potential benefit.
This X Ray shows the diseased cap of bone to the lower right of the picture. The growth plate is the dark strip between the two white parts of bone.
Is Sever’s Disease the right diagnosis?
The answer is a little complicated. Podiatrists generally use this term to describe this condition, pretty much from the first appearance of the pain. True Sever’s Disease though, does involve changes to the bone appreciable on X Ray. It would be more correct to term the early condition Calcaneal Apophysitis, Calcaneal Epiphysitis or Calcaneal Osteochondrosis. We think that putting these under the umbrella of Sever’s Disease is a reasonable thing to do. The term is simpler and more easily remembered by kids and parents.
Sever’s Disease: Heel Pain in Children
This post has been written to answer questions about Sever’s disease treatment and the treatment of severs disease. It pertains to heel pain in children and especially foot pain after sport occurring in kids. This condition may also be known as Calcaneal Epiphysitis, Calcaneal Avascular Necrosis and Osteochondrosis.