It is thought to be a traction injury, where the Achilles tendon and Plantar fascia pull in opposite directions. Sever?s occurs in children aged 8 to 16 years old. In children, the heel bone is made
up of 2 bones, with a growth plate of cartilage in between the sections, holding these 2 bones together. As the cartilage expands, the edges of it eventually turn to bone, and finally the gap closes.
This usually occurs within the first 13-15 years of life. However, because these bones are connected by cartilage they are weaker than normal bones. This is why they are very vulnerable to
Sever's disease can result from standing too long, which puts constant pressure on the heel. Poor-fitting shoes can contribute to the condition by not providing enough support or padding for the feet
or by rubbing against the back of the heel. Although Sever's disease can occur in any child, these conditions increase the chances of it happening. Pronated foot (a foot that rolls in at the ankle
when walking), which causes tightness and twisting of the Achilles tendon, thus increasing its pull on the heel's growth plate, flat or high arch, which affects the angle of the heel within the foot,
causing tightness and shortening of the Achilles tendon, short leg syndrome (one leg is shorter than the other), which causes the foot on the short leg to bend downward to reach the ground, pulling
on the Achilles tendon, overweight or obesity, which puts weight-related pressure on the growth plate
The main symptom of sever's disease is pain and tenderness at the back of the heel which is made worse with physical activity. Tenderness will be felt especially if you press in or give the back of
the heel a squeeze from the sides. There may be a lump over the painful area. Another sign is tight calf muscles resulting with reduced range of motion at the ankle. Pain may go away after a period
of rest from sporting activities only to return when the young person goes back to training.
Sever's disease is diagnosed based on a doctor?s physical examination of the lower leg, ankle, and foot. If the diagnosis is in question, the doctor may order X-rays or an MRI to determine if there
are other injuries that may be causing the heel pain.
Non Surgical Treatment
Sever?s disease treatment should be based on eliminating pain and restoring normal foot and leg biomechanics. As with most soft tissue injuries the initial treatment is Rest, Ice, and Protect. In the
early phase you?ll most likely be unable to walk pain-free. Our first aim is to provide you with some active rest from pain-provoking activities. "No Pain. No Gain." does not apply in Sever's
disease. If it hurts your child is doing too much exercise. Your child should reduce or cease any activity that causes heel pain. Ice is a simple and effective modality to reduce your pain and
swelling. Please apply for 20-30 minutes each 2 to 4 hours during the initial phase or when you notice that your injury is warm or hot. Most children can tolerate paracetamol as a pain reducing
medication. Check with your doctor. To support and protect your heels, you may need to be wear shock absorbing heel cups or a soft orthotic. Kinesio foot taping may help to provide pain relief. Your
physiotherapist will guide you and utilise a range of pain relieving techniques including joint mobilisations for stiff ankle or subtalar joints, massage or electrotherapy to assist you during this
The best way to prevent Sever?s disease is for your child to stay flexible and stretch the hamstring, calf muscles, and the Achilles tendon before and after activity each day. It?s important to hold
the stretches for 20 seconds and stretch both legs, even if there is only pain in one. If he or she only has smaller symptoms, like swelling and some tenderness, consider your child lucky. They may
only have to sit out for one to two weeks during the season. The best treatment is to immediately stop the activity that caused the pain. Elevate and ice the heel for 20 minutes at a time to relieve
discomfort and swelling.