Severs Disease is a common cause of heel pain in children. It is seen most commonly in children aged 5 - 11 years old. Children with Severs Disease will complain of heel pain that increases with
activity. The pain is often relieved by rest, although some children will continue to have pain with regular activities, such as walking. Severs Disease has much in common with Osgood-Schlatter
Disease. Both are described as being a traction apophysitis.
The usual cause is directly related to overuse of the bone and tendons in the heel. This can come from playing sports or anything that involves a lot of heel movement. It can be associated with
starting a new sport, or the start of a new season, or too much weight bearing on the heel. Also, excessive traction could cause this, since the bones and tendons are still developing. Many children
who over pronate their feet exhibit symptoms and in most patients, it usually involves both heels.
The most prominent symptom of Sever's disease is heel pain which is usually aggravated by physical activity such as walking, running or jumping. The pain is localised to the posterior and plantar
side of the heel over the calcaneal apophysis. Sometimes, the pain may be so severe that it may cause limping and interfere with physical performance in sports. External appearance of the heel is
almost always normal, and signs of local disease such as edema, erythema (redness) are absent. The main diagnostic tool is pain on medial- lateral compression of the calcaneus in the area of growth
plate, so called squeeze test. Foot radiographs are usually normal. Therefore the diagnosis of Sever's disease is primarily clinical.
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
Treatment is initially focused on reducing the present pain and limitations and then on preventing recurrence. Limitation of activity (especially running and jumping) usually is necessary. In Micheli
and Ireland's study, 84% of 85 patients were able to resume sports activities after 2 months. If the symptoms are not severe enough to warrant limiting sports activities or if the patient and parents
are unwilling to miss a critical portion of the sport season, wearing a half-inch inner-shoe heel lift (at all times during ambulation), a monitored stretching program, presport and postsport icing,
and judicious use of anti-inflammatory agents normally reduce the symptoms and allow continued participation. If symptoms worsen, activity modification must be included. For severe cases, short-term
(2-3 weeks) cast treatment in mild equinus can be used.
The chances of a child developing heel pain can be reduced by avoiding obesity. Choosing well-constructed, supportive shoes that are appropriate for the child?s activity. Avoiding or limiting wearing
of cleated athletic shoes. Avoiding activity beyond a child?s ability.