Sever’s Disease and Why One Type of Athletic Shoe Virtually Guarantees Your Kid Will Get It.

Colin, 11, isn’t like the rest of his family. While his sister and brother are happy to read a book or play indoors on the iPad, Colin is always on his feet.  Between flag football, soccer, and field hockey, “there’s no sport he won’t play,” says his Mom.

Even the nagging pain in his heels can’t slow him down. “Doctors told him he needs to rest, but the next day he was bouncing on the trampoline again. It’s just not in his nature to sit still!”

Recently, Colin was diagnosed with Sever’s disease, one of the most common causes of heel pain in children ages 7-12.

What’s Sever’s Disease?

sever's disease and kids heel painSever’s disease, named for orthopedic surgeon James Sever, is characterized by inflammation of the apophysis. The apophysis is a growth plate located in the heel. As your child grows, the apophysis facilitates the development of the foot bones to reach their fully-mature, adult shape.

Sever’s disease is also known as calcaneal apophysitis. The repetitive trauma of long distance running, or excessive running in cleats, can irritate the apophysis, causing pain and inflammation.

The heel bone compresses into the bone above it, making it difficult for the foot to absorb shock on impact. The foot makes up for the deficit by over-pronating, or rolling inward, which strains the growth plate as well as the Achilles tendon.

Sever’s Disease and Plantar Fasciitis, what’s the difference?

Sever’s disease is often mistaken for plantar fasciitis, because both conditions cause severe heel pain, and both tend to affect athletes.

Plantar fasciitis refers to inflammation of the plantar fascia, the thick band of tissue connecting the heel to the front of the foot. Patients with plantar fasciitis typically locate their pain in the spot where the arch meets the heel. It often feels like a stone in your shoe.

Sever’s disease pain usually originates in the back of the heel, and can spread to the Achilles tendon as well. The disease is more common in boys, and tends to affect both feet.

Severs Disease (heel pain) and cleats

What type of athletic shoe causes Sever’s Disease?

If your child regularly wears cleats for several hours a week, there’s a good chance he or she might develop Sever’s. Cleats concentrate the force of impact on your child’s heel. If your child has flatfeet or other arch abnormalities, this can also exacerbate the condition.

Another tell-tale sign? “Sever’s pain gets worse with activity, especially high-impact activities like running,” says physical therapist Suzanne Hawson, MPT, OCS. “Whereas plantar fasciitis pain peaks in the morning, and will usually subside later in the day, as the ligaments loosen up.”

Lastly, plantar fasciitis is more common in adults than in children, while Sever’s mostly affects kids. Sever’s Disease usually goes away on its own, once the growth plate closes and your child’s foot is finished growing.

How to diagnose Sever’s Disease and heel pain in children

To diagnose your child’s condition, a foot and ankle specialist needs to identify the particular mechanical dysfunction – the part that is either stuck or moving too much – that is causing your child’s pain.

“When it comes to diagnosing sports-related heel pain in children, the first thing we do is conduct a complete medical history and physical exam,” says Dr. Bob Baravarian, podiatric foot and ankle specialist. “Most of the time, there’s no need for an X-ray.”

From the outside, the foot will appear normal, with no redness or swelling. “We can make a diagnosis using a simple squeeze test, right here in the clinic.”

What are some treatments for Sever’s Disease?

Sever’s can be successfully treated with physical therapy, which may include:

  • Foot and ankle manipulation for better alignment and weight bearing
  • Re-training healthier walking and running styles
  • Correcting posture
  • Balance and core strength training
  • Shoe assessment and analysis
  • Immobilization in a cast or boot, as a last resort

While orthotics (such as heel cups or shoe inserts) can help to manage heel pain, they should be considered a temporary fix. Orthotics on their own won’t address the underlying issue.

physical therapy for heel pain and sever's disease

Prevention of Sever’s Disease in children

If you have an active child, especially one who spends time in cleats, take her to the physical therapist for regular check-ups every six months.

“Just like a cleaning at the dentist, a visit to your physical therapist can help your child avoid injury,” Hawson says. A trained physical therapist can teach your child better posture and body mechanics as injury prevention techniques for on and off the field. Learning how to move properly can help your active child to avoid a more serious sports-related injury in the future.

The physicians at University Foot and Ankle Institute have decades of combined experience effectively treating adult and children’s foot pain. We are leaders in the field of research and treatment of all foot and ankle conditions.

If you would like more information or to schedule a consultation, please call (877) 475-1678 or visit us at www.footankleinstitute.com.

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