What is Sever’s?

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Sever’s Disease, technically known as Calcaneal Apophysitis, is a very common childhood complaint. It is most commonly seen between the ages of 9-13 years old, and generally affects boys more than girls.

Severs is classified as an overuse injury and the cause of the pain is irritation by the achilles tendon on the growth plate line in your calcaneus (heel bone). The symptoms and onset can range widely between kids, as they all go through growth spurts are varying stages, and the sports in which they are involved in differ.

Here are a few ‘classic’ symptoms in which to be aware of:   

  • Pain and stiffness at the back of the heel, especially after periods of time being non-weight bearing eg sleeping, watching a movie
  • Heel pain during physical exercises which involve running and jumping, and landing.
  • Pain will often disappear or be very mild during exercise whilst the area is ‘warm’ but will be sore following exercise once they have cooled down.

Treatment of Severs can vary depending on the severity, and duration of the symptoms. Typically I have found that addressing the following 5 key causative factors, lead to a reduction in symptomatic pain initially, and also the reduce the risk of any ‘flare ups’ down the track until the growth plate ossifies around the age of 14-15 years old.

The top 5 factors to address for any child with Severs:

  1. Footwear
    Sounds simple, but appropriate footwear can make a world of difference. Ensure that your child is wearing the most appropriate shoe(s) for the activities that they are undertaking.
  2. Inefficiencies within foot and ankle biomechanics
    The introduction of a flexible and functional orthotic device to shoes that the child spends most time in (ie school shoes), to address any inefficiencies within the child’s foot mechanics, and help de-load the achilles tendon. This will help improve the symptoms, and reduce the risk of any ‘flare ups’ down the track.
  3. Pain relief
    Children have high pain thresholds, and can quickly ‘forget’ about pain if attention is diverted elsewhere. But if the pain is persistent, then the use of a heat pack, place over the back of the heel and along the length of the achilles can work well. If stronger pain relief is required then using a children’s paracetamol may be required.
  4. Strength and flexibility
    One of the most important factors to consider in any musculoskeletal injury. Simply put that if the muscle(s) do not have the adequate strength and/or flexibility to withstand the stresses placed upon it, then eventually it will breakdown and become dysfunctional.
  5. Shock attenuation/landing ability
    The calf muscles and achilles tendon act like ‘springs’ to absorb force’s placed upon them, then recoil to aid in propulsion. If these structures are not able to absorb or attenuate these forces, then they become stressed and potentially dysfunctional. Landing ability, like any skill, if we are not shown to how to appropriately execute a task, then the risk of repeating that same task the wrong way is very high, and this is where injuries can develop.

Of course there are more factors that will need to be addressed, but a progressive management plan, provided to you by your Podiatrist, should always address the key factors listed above.

If you have any specific questions, please feel free to contact me on 01-5394322 0r 042 9334351 or email me at [email protected]

Justin Blake

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