Sever’s disease is a disorder that commonly occurs in active children between the ages of 9 and 13 years of age. Even though it is misnamed as a disease, it is actually a self-limiting disorder that occurs around the growth plate in the back of the heel.
The Achilles tendon attaches to the upper portion of the heel growth plate. On the bottom of the growth plate is an attachment of a ligament known as the plantar fascia. With increased activity, there is a pulling or tugging that occurs on this growth plate, and a portion of the growth plate is being pulled away from its attachment to the heel. X-rays are often taken to verify the position and location of this growth plate.
In mild cases, elevating the heel through heel lifts in the shoes and decreasing activity level may be enough to control the pain. In more severe cases, orthotic therapy to help control the motion of the heel, as well as icing, elevating, and aspirin therapy may be required to alleviate the symptoms. In those children who do not respond to either therapy mentioned above, it is sometimes necessary to place the child in a below-knee cast for a period of 4-6 weeks. It is important for both the child and parents to understand that the pain and swelling associated with this disorder should resolve once the growth plate has fused to the primary bone in the heel.
Please realize that the disorder may last only a couple of weeks to as long as 1-2 years. The treatment plan as prescribed by your doctor MUST be adhered to closely, and the activity level of the child must be controlled during the early stages of treatment. All jumping and running sports, such as basketball, trampoline, volleyball, tennis, soccer, etc., must be eliminated as part of the initial treatment. Once the child has improved and the pain has subsided, a rigid stretching program must then be implemented. This is provided to you at the end of this information sheet.
The purpose of the stretching program is to decrease the pull of the Achilles tendon on the growth plate. In the event that the stretching program and the heel lifts do not provide relief of symptoms, the next course of therapy is to limit the amount of motion of the heel through inserts in the shoes called orthotics. The orthotics accomplish two basic functions: (1) To elevate the heel and decrease the pull of the Achilles tendon. (2) To prevent the rocking motion of the heel while the child is active. Typically, we have found that the majority of the children will respond favorably to this type of conservative care and be able to actively return to their respective sport with very little compromise. In those cases that do not respond well to conservative therapy, it is sometimes necessary to take the child out of the sport which is aggravating the condition until such time that the growth plate fuses to the main bone of the heel.
We, the doctors and staff at Beaumont Foot Specialists, are here to help you and your child return to a normal level of activity as quickly as possible. If there are any questions or concerns regarding this disorder or treatment, please feel free to talk openly with us.
- Discontinue all running, jumping, etc. activities.
- Application of ice to the affected heel, 10 minutes on and 20 minutes off, for 2-3 hours.
- Aspirin as directed.
- Heel lift.
- Discontinue all strenuous activity.
- Ice and elevation to the affected heel.
- Anti-inflammatory medication.
- Temporary orthotics with heel lift to be worn in all shoes.
- No weight-bearing to the affected foot, crutch walking only.
- Below-knee casting for a period of 4-6 weeks.
- Anti-inflammatory medication.
- Treatment to follow based on symptoms after removing cast, i.e. moderate/mild.
CALF/ACHILLES TENDON STRETCH
- Lean your forearms against a solid support with your head resting on your arms. Stretch your right leg behind you keeping it straight with heel on the ground and toe pointed straight ahead. Bend your left leg and place it in front of you, heel flat. Keeping your back straight and both feet flat on the ground, move your hips forward. Hold the stretch. Repeat several times. Reverse the position of the legs and repeat.
- In the same starting position, bend you left leg so that both legs are bent. Hold the stretch. Repeat several times. Reverse the position of the legs and repeat.