Sever’s disease is mainly a cause of heel pain in kids affecting active children aged 8 to 15 years old. Pain at the back of the heel from overuse that if managed correctly, is something the young athlete should grow out of. Rest is an essential part of treatment along with ice or cold therapy and managing training loads.
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.
Severs disease is often associated with a rapid growth spurt. As the bones get longer, the muscles and tendons become tighter as they cannot keep up with the bone growth.
The point at which the Achilles tendon attaches to the heel becomes inflamed and the bone starts to crumble (a lot like osgood schlatters disease of the knee).
Tight calf muscles may contribute as the range of motion at the ankle is reduced resulting in more strain on the Achilles tendon. Sever’s disease is the second most common injury of this type which is known as an apophysitis.
The aim of treatment is to reduce the pain and inflammation when gently stretch the muscles. There is likely to be no magic instant cure and the young athlete may have to be patient while they grow
Apply the PRICE principles of protection, rest, ice, compression and elevation. Rest from any activity which makes the injury worse. Initally, certainly the first 48 to 72 hours this will mean complete rest. Later on when normal daily activities can be done pain free then modifying training to avoid certain activities which increase pain should be done. This is likely to include running, jumping and any sports which involve this kind of weight bearing, high impact activity. It may be necessary to stick to swimming or cycling until the injury has completely cleared up.
Apply ice or cold therapy for 10 mins every hour initially, reducing frequency as symptoms improve. Do not apply ice directly to the skin but wrap in a wet tea towel or better still use a cold therapy and compression wrap. Insert a heel pad or heel raise into the shoes. This has the effect of raising the heel and shortening the calf muscles and so taking the strain off the back of the heel. However long term use of a heal raise may shorten the calf muscles when they need stretching.
A doctor or physiotherapist can apply a plaster cast or boot if the child is in severe pain. This may be worn for a few days or even weeks and should give relief of pain for a while. The will carry out a full biomechanical assessment to help to determine if any foot biomechanics issues are contributing to the condition. Orthotics or insoles can be prescribed to help correct over pronation or other biomechanics issues.
They may prescribe anti-inflammatory medication such as ibuprofen to reduce pain and inflammation. This will not be prescribed the child has asthma. In persistent cases X-rays may be taken but this is not usual. A sports injury professional will NOT give a steroid injection or operate as these are not suitable treatment options. The condition will usually settle within 6 months, although it can persist for longer.
Stretch the calf muscles regularly. Stretching should be done pain free and very gently with this injury. Sports massage can help improve the condition of the soft tissue and joint flexibility. Strengthening exercises are not usually recommended for treating Servers disease as it is an over use injury and requires rest. When returning to sport the load through the tendon should be gradually increased. Do not go straight back to full training or the injury may recur.
Most of us will not present with this condition. But if you have kids who have not quite hit their growth spurt….keep an eye out.