Sever's Disease - Severs Disease

Sever's Disease, otherwise known as calcaneal apophysitis is an inflammation of the growth plate in the heel of growing children, typically adolescents. The condition presents as pain in the heel and is caused by repetitive stress to the heel and is thus particularly common in active children. It usually resolves when the bone has completed growth or activity is lessened.

Eponym

It is named for James Warren Sever (1878â€"1964), an American Orthopedic doctor, who characterized it in 1912. Dr Sever had "The Principles of Orthopaedic Surgery" published in 1940 by The Macmillan Company.

Symptoms

The most prominent symptom of Sever's disease is heel pain which is usually aggravated by physical activity such as walking, running or jumping. The pain is localised to the posterior and plantar side of the heel over the calcaneal apophysis. Sometimes, the pain may be so severe that it may cause limping and interfere with physical performance in sports. External appearance of the heel is almost always normal, and signs of local disease such as edema, erythema (redness) are absent. The main diagnostic tool is pain on medial- lateral compression of the calcaneus in the area of growth plate, so called squeeze test. Foot radiographs are usually normal. Therefore, the diagnosis of Sever's disease is primarily clinical.

Cause

Sever's disease is directly related to overuse of the bone and tendons in the heel. This can come from playing sports or anything that involves a lot of heel movement. It can be associated with starting a new sport, or the start of a new season. Children who are going through adolescence are also at risk of getting it because the heel bone grows quicker than the leg. Too much weight bearing on the heel can also cause it, as can excessive traction since the bones and tendons are still developing. It occurs more commonly in children who over-pronate, and involves both heels in more than half of patients.

Treatment

Treatment may consist of one or more of the following:

• Elevating the heel
• Stretching hamstring and calf muscles 2â€"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 shoes

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 by the authors. The study was presented at the European College of Sports Science - 13th Congress Proceedings Estoril,Portugal, July 9â€"12, 2008. Clinical study - Electronic Version ISSN 1536-7290

Recovery

Sever's disease is self-recovering, meaning that it will go away on its own when the foot is used less or when the bone is through growing. The condition is not expected to create any long-term disability, and expected to subside in 2â€"8 weeks. Some orthopedic surgeons will put the affected foot in a cast to immobilize it.

While symptoms can resolve quickly, they can recur. Sever's disease is more common in boys than girls; the average age of symptom onset is nine to eleven years.

Prevention

• Maintain good flexibility through stretching exercises
• Avoid excessive running on hard surfaces
• Use quality, well-fitting shoes with firm support and a shock-absorbent sole