Does your child have pain at the back of their heel? Do they limp after sport? Are they aged between 8-12?
It could be Sever’s Disease – It’s not a disease really, Sever’s is the name of the guy who first described it – over 100 years ago!
We call it Calcaneal Apophsiitis – Its a type of growing pain where the growth plate in the heel bone becomes inflammed and angry. Commonly seen at the beginning of the sport season or during a spike in activity.
Diagnosis is best made via a thorough history, symptoms and a physical examination. Most commonly, direct palpation of the growth plate, and a ‘squeeze test’ of the heel can confirm diagnosis. An X-ray is not required for diagnosis, in fact all that does is show that the growth plate exists – which of course it does in adolescents.
Often we see the child limping, sometimes walking on their toes. A stiff ankle, a tight calf and sometimes high arches or flatter feet can be contributing factors. Flat shoes such as flexible soccer boots can also increase the risk.
Excessive forces through the heel are mainly to blame in an active child. If the calf is tight the Achilles Tendon attachment may pull on the back of the heel (see top arrow). This creates friction in the growth plate. Also, direct pressure from the ground can compress the bottom of the growth plate contributing to pain (see bottom arrow).
The good news – even if you do nothing the growth plate WILL fuse one day as the foot matures. However it doesn’t mean your child should suffer in pain.
Treatment is based on reducing symptoms and improving function.
Pain management is key – Dencorub before sport and Ice after.
Only cease sport if the pain is above a 3/10 on the pain scale (10 being the worst) or if it causing a limp.
Initially, favour a slightly higher heel in the shoe for the short term – the addition of a soft heel raise from a Podiatrist can help. Restoring normal range of motion of the ankle and foot must be achieved. Manual therapy including release work, stretching and soft heel wedges work well.
Moving forward, strength of the calf and foot is key to prevent return. Sometimes orthotics can help stabilise the rearfoot too.
Other considerations include glute and general leg control, footwear analysis and Running Technique work.
Accurate diagnosis is key, don’t be afraid to get help.
We can’t accelerate the maturity of the growth plate, but we can reduce pain, improve function and help maintain a happy active child.
Phil de Mestre – Sports Podiatrist and Runner