Sever’s Disease, or calcaneal apophysitis, is the most common cause of heel pain in children and adolescents. Pain is usually isolated to the insertion of the Achilles tendon onto the back of the heel bone. This type of injury is referred to as a “traction apophysitis” where the tendon pulls on the bone, creating irritation.
Who?
This condition commonly coincides with growth spurts, and is therefore seen mostly in those aged 7-10 years.
Why?
When a child or adolescent experiences a growth spurt, the bones lengthen first, and there is a time-lapse as the muscles catch up. In this period, the muscles are relatively short and tight compared to the lengthened bone. When this happens the tensioned muscle pulls on its bony attachment, causing irritation.
Symptoms
- Pain is usually pinpoint to the back of the heel and increases during or after sport
- Pain may cause a limp in some cases
Management
In many cases, Severs Disease responds well to Physiotherapy management. This may consist of:
- Orthotic prescription – an orthotic or heel raise can take the pressure off the painful area
- Calf soft tissue massage - can reduce calf tightness, thus reducing traction at the calf’s insertion
- Icing – can settle irritation at the heel
- Strengthening to improve lower limb biomechanics (i.e. hip, knee and calf strength)
- In some cases, activity levels may need to be modified to allow pain to settle. Exercise is not harmful but can increase pain.
- Please note: contrary to popular opinion, it is important to avoid calf stretches initially. Although the calf is tight, stretching it simply tensions the muscle further and increases pulling on the already irritated attachment sight. A foam roller can be a good tool to provide a similar effect without increasing the traction.
Prognosis
- Children with this condition recover completely with no long term issues
- In rare cases, pain may continue for up to 2 years as growth continues, however will often settle in months with appropriate treatment
By Tom Collier (Physiotherapist)
Tom has attended additional courses in common injuries in adolescent athletes.
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