Will Severs Disease Need Surgery?

posted on 23 May 2015 02:07 by iraaudette
Overview

Sever's disease or calcaneal apophysitis heel pain is a common problem with children between the ages of 8 to 13 years. It has usually been more common in boys, but with the increase of girls in athletic activities, both sexes are having equal symptoms. A high percentage of these children have tight achilles tendons and hamstrings. This condition may occur in the foot with normal arch height or flat or pronated foot, but can be especially painful in the high arch foot.

Causes

Children are at a higher risk of developing Sever's disease when they are in the early stages of a growth spurt. During times of growth, muscles and tendons become extremely tight. Movements during athletic activities like soccer, tennis, and gymnastics can put added force on the growth plate in the heel, which is pulled tight by the Achilles tendon. Over time, the growth plate becomes inflamed and painful. There are several other factors that can increase a child's risk of developing Sever's disease, including the following. Excessive pronation. Flat or high arches. Short Achilles tendon. Weight gain (which results in more force on the feet).

Symptoms

The most obvious sign of Sever's disease is pain or tenderness in one or both heels, usually at the back. The pain also might extend to the sides and bottom of the heel, ending near the arch of the foot. A child also may have these related problems, swelling and redness in the heel, difficulty walking, discomfort or stiffness in the feet upon awaking, discomfort when the heel is squeezed on both sides, an unusual walk, such as walking with a limp or on tiptoes to avoid putting pressure on the heel. Symptoms are usually worse during or after activity and get better with rest.

Diagnosis

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.

Non Surgical Treatment

Treatment may consist of one or more of the following. Elevating the heel. Stretching hamstring and calf muscles 2-3 times daily. Using R.I.C.E. (Rest, Ice, Compression, Elevation). Foot orthotics. Medication. Physical therapy. Icing daily (morning). Heating therapy. Open back shoe are best and avoid high heel shoe. The Strickland Protocol has shown a positive response in patients with a mean return to sport in less than 3 weeks. Further research into the anatomical and biomechanical responses of this protocol are currently being undertaken.