Traditionally, the disease was thought to affect males much more predominately, but now that we are seeing more young women athletes, the incidence is nearing the same between genders. Sever's disease is medically described as osteochondritis of the calcaneal apophysis. This is an injury to the growth plate in the back of your heal. During development, all bones in the body start as cartilage and fill in with calcium and other minerals to create a strong skeleton. This process is referred to as ossification. The calcaneus, or heel bone, has two separate areas of ossification that are connected by the cartilaginous growth plate. Because of overuse or tight muscles, these two ossification centers are pulled away from each other causing strain on the growth plate. Overtime simple activities such as running, jumping or even standing can cause severe heel pain. I will often see children limping into my office when they have this condition. Luckily, this is a self limiting condition meaning it will eventually go away.
Unfortunately, children will have to tone down their activity schedule to reduce the pain. It is important to make the children as comfortable as possible and keep them active in their favorite's sports, but we also have to be reasonable in the treatment options. Physical therapy will help the child stretch the muscles to decrease the pull on the developing calcaneus and Thera-band exercises can be used to strengthen the area. Ice massages will also help decrease the inflammation which is the culprit of pain. Heel lifts placed in the shoes, to decrease the pressure of the Achilles tendon on the calcaneus , and orthoses can also bring relief. Occasionally, there is need for a cast to immobilize the area to ensure proper healing. Though NSAIDS can bring relief to pain, large does are not always recommended for children. Thus, I prefer to have children to try topical pain relievers first.
Since Sever's Disease can last up to 18 months, it is important to treat it aggressively soon as possible. Thus the child is not stuck on the bench, disappointed in their inability to perform. It may be necessary to take a short break from vigorous sports or exercise to allow proper healing time, but that is much better than sitting on the bench for an entire year!
Dr. Peter Wishnie is a podiatrist who specializes in foot and ankle surgery. His office is in Piscataway/Hillsborough,NJ. His goals are to educate the public on the care of their feet and ankles and to get them functioning as quickly as possible. For more foot health tips on foot pain, get a Free copy of their book, "Stop Foot Pain Fast," by visiting their website: http://www.stopfootpainfast.com
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