Physical Rehabilitation For Severs Disease

Overview

Sever's disease is a common cause of heel pain in adolescence. Developing, physically active ?kids? are more prone to Sever's. During puberty the calcaneus consist of two developing sites of bone known as ossification centres. These two areas are seperated by an area of cartilage known as the calcaneal apophysis. The Achilles tendon attaches the triceps surae (calf muscles) to the calcaneus (heel bone). As a child grows the calcaneus grows faster than the surrounding soft tissue, which means the Achilles tendon is pulled uncomfortably tight. This increase in strain causes inflammation and irritation of the calcaneal apophysis (growth plate) which is known as Sever's Disease. The pain is exacerbated by physical activities, especially ones involving running or jumping. Sever's disease most commonly affects boys aged 12 to 14 years and girls aged 10 to 12 years, which corresponds with the early growth spurts of puberty.

Causes

Children are at a higher risk of developing Sever's disease when they are in the early stages of a growth spurt. During times of growth, muscles and tendons become extremely tight. Movements during athletic activities like soccer, tennis, and gymnastics can put added force on the growth plate in the heel, which is pulled tight by the Achilles tendon. Over time, the growth plate becomes inflamed and painful. There are several other factors that can increase a child's risk of developing Sever's disease, including the following. Excessive pronation. Flat or high arches. Short Achilles tendon. Weight gain (which results in more force on the feet).

Symptoms

Pain is usually felt at the back of the heel and around the sides of the heel. If you squeeze the back of the heel from both sides simultaneously and pain is experienced Sever?s disease is more than likely present.

Diagnosis

Your podiatrist will take a comprehensive medical history and perform a physical examination including a gait analysis. The assessment will include foot posture assessment, joint flexibility (or range of motion), biomechanical assessment of the foot, ankle and leg, foot and leg muscle strength testing, footwear assessment, school shoes and athletic footwear, gait analysis, to look for abnormalities in the way the feet move during gait, Pain provocation tests eg calcaneal squeeze test. X-rays are not usually required to diagnose Sever?s disease.

Non Surgical Treatment

Management consists of explanation of what's happening and advice on activity modification to get it to settle. Icing after activity and heating during breaks in activity also often help. Local treatment with electrotherapy may be indicated in the acute stage or to help settle pain for a specific activity/competition. Stretches will be advised and the child may require orthotics to control foot position. A heel raise or heel cups may also help. Strapping may be of some benefit. The mainstay of treatment however is the icing and activity modification and reassurance that the condition is self-limiting, this may take up to 2 years.

Prevention

Because there are several theories as to the actual cause of the disease, there is no definitive answer on prevention. Experts agree, though, that youth athletes can help minimize the risk of Sever's disease by maintaining good joint and muscle flexibility while engaging in sports or physical activities.

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