Sever?s is described as a traction apophysitis. In childhood our bones are made of a cartilage mould of the bone, which over time as we grow slowly turns into a full bone. The reason for this is that it is easier to grow cartilage to the length required, and then back fill with bone later than it is to actually grow new bone. Most bones have a least two growth of bone centres, one by the joint and one making the main body of the bone. In the growing heel bone (calcaneus) the posterior part has a separate growth area where the Achilles tendon attaches. When playing lots of sport, especially football, rugby and hockey, the two areas of bone can be pulled apart, producing pain. Recent evidence has also suggested that the appearance of this condition on MRI (magnetic resonance imaging), appears to indicate that Sever?s is a type of stress fracture. Whether that fatigue stress is from compression or tension remains in debate, and is probably a combination of both.
Physically active children run the risk of developing Sever?s disease because they put the most strain on their growing bones. Sever?s usually occurs during the adolescent growth spurt, when young people grow most rapidly. (This growth spurt can begin any time between the ages of 8 and 13 for girls and 10 and 15 for boys.) By age 15 the back of the heel usually finished growing. As teens grow, the growth plates harden and the growing bones fuse together into mature bone. Young people engaged in physical activities and sports that involve jumping and running on hard surfaces-such as track, basketball, soccer, and gymnastics-are ata higher risk for developing Sever?s disease. Poor-fitting shoes can contribute by not providing enough support or padding for the feet or by rubbing against the back of the heel.
The typical patient is a child between 10 and 13 years of age, complaining of pain in one or both heels with running and walking. The pain is localized to the point of the heel where the tendo-achilles inserts into the calcaneus (heel bone), and is tender to deep pressure at that site. Walking on his toes relieves the pain.
A physical exam of the heel will show tenderness over the back of the heel but not in the Achilles tendon or plantar fascia. There may be tightness in the calf muscle, which contributes to tension on the heel. The tendons in the heel get stretched more in patients with flat feet. There is greater impact force on the heels of athletes with a high-arched, rigid foot. The doctor may order an x-ray because x-rays can confirm how mature the growth center is and if there are other sources of heel pain, such as a stress fracture or bone cyst. However, x-rays are not necessary to diagnose Sever?s disease, and it is not possible to make the diagnosis based on the x-ray alone.
Non Surgical Treatment
There is nothing you can do to stop severs disease. It will stop when you finish growing. However the following will help to relieve the symptoms. Rest. Cut down on the time you spend playing sport until the pain has gone. Avoid sports that involve a lot of running or jumping. Swimming can be a useful alternative. Ice the affected area for ten to 15 minutes, especially after activity. Make sure you protect the skin by wrapping the ice in a towel. Elevate (raise) the leg when painful and swollen especially after sports. Pain relieving medication may reduce pain and swelling, but you need to discuss options with a pharmacist or GP. Always wear shoes. Avoid activities in bare feet. Choose a supportive shoe with the laces done up.