Does Severs Disease Often Necessitate Surgical Treatment?
Overview
Sever's disease (calcaneal apophysitis) is an inflammatory condition that affects the heel bone (calcaneus). It happens frequently in young athletes between the ages of 10 and 13, causing pain in one or both heels when walking. Tenderness and swelling may also be present. Similar to another overuse condition, Osgood-Schlatter disease, Sever's disease has occasionally been termed Osgood-Schlatter of the heel. In young people, the heel bones are still divided by a layer of cartilage. During the growth years, the bone is growing faster than tendons. This makes it likely that the heel cord will be applying great tension where it inserts into the heel bone. In addition, the heel cord is attached to an immature portion of the heel bone, the calcaneal apophysis. In young athletes, the repetitive stress of running and jumping while playing soccer and basketball may cause an inflammation of the growth center of the heel.
Causes
Sever?s disease is caused by repetitive tension and/or pressure on the growth center of the heel. Running and jumping place a large amount of pressure on the heels and can cause pain. Children with Sever?s may limp or have an altered gait due to the pain. Risk factors for Sever's include tight calf muscles, weak ankle muscles, and alignment abnormalities at the foot and ankle. Sever?s can also result from wearing shoes without sufficient heel padding or arch support.
Symptoms
This is a condition that affects the cartilage growth plate and the separate island of growing bone on the back of the heel bone. This growth plate is called the physeal plate. The island of growing bone is called the apophysis. It has the insertion attachment of the Achilles tendon, and the attachment of the plantar fascia. This island of bone is under traction from both of these soft tissue tendon and tendon-like attachments.
Diagnosis
This can include physical examination and x-ray evaluation. X-rays may show some increased density or sclerosis of the apophysis (island of bone on the back of the heel). This problem may be on one side or bilateral.
Non Surgical Treatment
Sever?s disease will go away on its own with rest or after heel bone growth is complete, usually within 2 to 8 weeks after the heel pain or discomfort appears. Sever?s disease is not expected to cause long-term problems, though symptoms may linger for up to several years in severe cases. Certain conservative care measures may be helpful in treating this health problem, including avoiding activities that provoke pain or discomfort, elevating the leg while at rest, performing hamstring and calf muscle stretches two to three times per day, undergoing physical therapy, using cold therapy, using an elastic wrap or compression stocking, Avoiding footwear with heel elevation, toe spring, and toe taper, and instead favoring footwear that?s completely flat and widest at the ends of the toes. More aggressive treatment measures, including over-the-counter anti-inflammatory medication (e.g. ibuprofen), steroid injections, and surgery, may be indicated in certain cases. Addressing the footwear component of this health problem is an important part of a well-rounded Sever?s disease treatment plan. Optimal footwear for preventing or treating this problem is flat, wide (widest at the ends of the toes), and flexible in the sole. Open-back footwear (such as certain Crocs models) may be particularly helpful for kids and teens with Sever?s disease.
Sever's disease (calcaneal apophysitis) is an inflammatory condition that affects the heel bone (calcaneus). It happens frequently in young athletes between the ages of 10 and 13, causing pain in one or both heels when walking. Tenderness and swelling may also be present. Similar to another overuse condition, Osgood-Schlatter disease, Sever's disease has occasionally been termed Osgood-Schlatter of the heel. In young people, the heel bones are still divided by a layer of cartilage. During the growth years, the bone is growing faster than tendons. This makes it likely that the heel cord will be applying great tension where it inserts into the heel bone. In addition, the heel cord is attached to an immature portion of the heel bone, the calcaneal apophysis. In young athletes, the repetitive stress of running and jumping while playing soccer and basketball may cause an inflammation of the growth center of the heel.
Causes
Sever?s disease is caused by repetitive tension and/or pressure on the growth center of the heel. Running and jumping place a large amount of pressure on the heels and can cause pain. Children with Sever?s may limp or have an altered gait due to the pain. Risk factors for Sever's include tight calf muscles, weak ankle muscles, and alignment abnormalities at the foot and ankle. Sever?s can also result from wearing shoes without sufficient heel padding or arch support.
Symptoms
This is a condition that affects the cartilage growth plate and the separate island of growing bone on the back of the heel bone. This growth plate is called the physeal plate. The island of growing bone is called the apophysis. It has the insertion attachment of the Achilles tendon, and the attachment of the plantar fascia. This island of bone is under traction from both of these soft tissue tendon and tendon-like attachments.
Diagnosis
This can include physical examination and x-ray evaluation. X-rays may show some increased density or sclerosis of the apophysis (island of bone on the back of the heel). This problem may be on one side or bilateral.
Non Surgical Treatment
Sever?s disease will go away on its own with rest or after heel bone growth is complete, usually within 2 to 8 weeks after the heel pain or discomfort appears. Sever?s disease is not expected to cause long-term problems, though symptoms may linger for up to several years in severe cases. Certain conservative care measures may be helpful in treating this health problem, including avoiding activities that provoke pain or discomfort, elevating the leg while at rest, performing hamstring and calf muscle stretches two to three times per day, undergoing physical therapy, using cold therapy, using an elastic wrap or compression stocking, Avoiding footwear with heel elevation, toe spring, and toe taper, and instead favoring footwear that?s completely flat and widest at the ends of the toes. More aggressive treatment measures, including over-the-counter anti-inflammatory medication (e.g. ibuprofen), steroid injections, and surgery, may be indicated in certain cases. Addressing the footwear component of this health problem is an important part of a well-rounded Sever?s disease treatment plan. Optimal footwear for preventing or treating this problem is flat, wide (widest at the ends of the toes), and flexible in the sole. Open-back footwear (such as certain Crocs models) may be particularly helpful for kids and teens with Sever?s disease.
