Severs Disease
Pain in the heel of children and young teenagers is almost always due to Severs Disease or calcaneal apophysitis. This is a condition of the growing area of the bone.
In the normal heel bone, like other bones, starts of as life as a cartilage framework that the bone develops in. The bone develops as the main body and also as a plate at the back of the heel bone. Up until the mid-teens, these two areas of developing bone are separated by a plate of cartilage. Severs disease is an irritation of this cartilage plate between the two areas of bone. The problem is self-limiting in that by the mid-teenage years the two areas of bone merge to form one heel bone.
The cause of Severs disease is too much load on the growth plate. This load cones from two sources. One is that the Achilles tendon is attached to the back of the growth plate and put a lot of load through it. A tighter calf muscles will make this worse. The other is hard sports grounds also increase the impact that goes through the growth plate. It has been suggested that Severs disease is more common early on in the winter sports season when the ground are still hard from the summer.
The symptoms of Severs Disease are pain with activity at the back of the heel. Pain or discomfort is also present when you squeeze the heel bone on the sides near the back. The pain progressively gets worse with sports activity.
The first approach to treat Severs disease is to reduce the activity levels of the child to a tolerable amount. Ice therapy after exercise can also help. A cushioned heel raise is usually used to reduce the pull from the Achilles tendon and cushioned the damaged area. Stretching for the calf muscles is also very important. If this does not help, a further reduction is needed in the activity levels of the child. Sometimes strapping is used to prevent full dorsiflexion of the foot. If the foot is very flat, then foot orthotics are occasionally used. If none of that is helping, then a full withdrawal from sport is indicated until healing has taken place. Following that there needs to be a gradual return to full activity levels so that it does not occur again.
