As children reach their growth spurt in early puberty, the heel is one of the first body parts to grow to full size. Because children's bones are growing so fast, the muscles or tendons can't keep up
and often become tight. The tight heel tendons can put a lot of stress on the heel, especially if a child is involved in athletics or other weight-bearing activity. Over time, too much pressure on
the heel can injure it and result in Sever's disease, also called calcaneal apophysitis.
Inflammation occurs at the insertion of the achilles tendon into the back of the heel due to a number of reasons. One or several of the following may cause the initiation of Sever?s disease. Rapid
growth spurt. Tight calf muscles. Change in footwear (soccer boots / athletic shoes no heel). Excessive rolling in of feet. Poor warm up routine. Remember this condition usually settles as the growth
plate fuses within 6-12 months.
Acute pain, pain asscoiatied with Sever?s disease is usually felt in the heel when the child engages in physical activity such as walking, jumping and or running. Highly active - children who are
very active are among the most susceptible in experiencing Sever?s disease, because of the stress and tension placed on their feet.
You may have pain when your doctor squeezes your heel bone. You may have pain when asked to stand or walk on your toes or on your heels. You may have pain in your heel when your doctor stretches your
calf muscles. Your doctor may order x-rays of the injured foot to show an active growth plate.
Non Surgical Treatment
Sever?s disease is a self-limiting problem, because as your child grows the growth plate will eventually fuse with the main body of the heel bone. This happens at about 14 -15 years of age. Once foot
growth is complete and the growth plate has fused, the symptoms will resolve. In the meantime, treatment by your Podiatrist will help your child return to normal sporting activities without heel pain
slowing him/her down.
The following exercises are commonly prescribed to patients with Severs disease. You should discuss the suitability of these exercises with your physiotherapist prior to beginning them. Generally,
they should be performed 1 - 3 times daily and only provided they do not cause or increase symptoms. Your physiotherapist can advise when it is appropriate to begin the initial exercises and
eventually progress to the intermediate, advanced and other exercises. As a general rule, addition of exercises or progression to more advanced exercises should take place provided there is no
increase in symptoms. Calf Stretch with Towel. Begin this stretch in long sitting with your leg to be stretched in front of you. Your knee and back should be straight and a towel or rigid band placed
around your foot as demonstrated. Using your foot, ankle and the towel, bring your toes towards your head as far as you can go without pain and provided you feel no more than a mild to moderate
stretch in the back of your calf, Achilles tendon or leg. Hold for 5 seconds and repeat 10 times at a mild to moderate stretch provided the exercise is pain free. Calf Stretch with Towel. Begin this
exercise with a resistance band around your foot and your foot and ankle held up towards your head. Slowly move your foot and ankle down against the resistance band as far as possible and comfortable
without pain, tightening your calf muscle. Very slowly return back to the starting position. Repeat 10 - 20 times provided the exercise is pain free. Once you can perform 20 repetitions consistently
without pain, the exercise can be progressed by gradually increasing the resistance of the band provided there is no increase in symptoms. Bridging. Begin this exercise lying on your back in the
position demonstrated. Slowly lift your bottom pushing through your feet, until your knees, hips and shoulders are in a straight line. Tighten your bottom muscles (gluteals) as you do this. Hold for
2 seconds then slowly lower your bottom back down. Repeat 10 times provided the exercise is pain free.