Sever's Disease is not a disease in the sense of an infection or other chronic pathology but is an injury/irritation of a growth plate. The Calcaneal growth plate or growth plate in the heel bone has
attachments from the achilles tendon and the plantar fascia. Pull from either or both of these structures can cause enough motion within the apophysis or growth plate space to create irritation and
inflammation which can be quite painful and limiting. This can start when the growth plate is still wide open but is more often seen as the growth plate starts to close further limiting its ability
to move with the traction of soft tissue attachments. It was believed by Sever that fractures within the growth plate were the source of the discomfort. When looking at a growth plate that has
started to close it can appear to be fragmented into 2 or 3 pieces. It has since been proven that this is the normal appearance of a closing growth plate.
Growth plates, also called epiphyseal plates, occur at the end of long bones in children who are still growing. These plates are at either end of growing bones, and are the place where cartilage
turns into bone. As children grow, these plates eventually become bone (a process called ossification). During a growth spurt, the bone in the heel may outpace the growth of the muscles and tendons
that are attached to the heel, such as the Achilles tendon. During weight bearing, the muscles and tendons begin to tighten, which in turn puts stress on the growth plate in the heel. The heel is not
very flexible, and the constant pressure on it begins to cause the symptoms of Sever?s disease. Sever?s disease is common, and it does not predispose a child to develop any other diseases or
conditions in the leg, foot, or heel. It typically resolves on its own.
Symptoms of Sever?s disease, mostly pain at the back of heel, usually occur during and after sporting activity, and usually disappear with rest. In some cases, children may find it difficult to place
pressure on their heels, and begin walking on their toes to gain relief. For some children, the heel pain will persist until the next morning, causing some stiffness or hobbling on first arising.
Some children may experience mild swelling at the back of the heel.
Radiography. Most of the time radiographs are not helpful because the calcaneal apophysis is frequently fragmented and dense in normal children. But they can be used to exclude other traumas.
Ultrasonography. could show the fragmentation of secondary nucleus of ossification of the calcaneus in severs?s disease. This is a safe diagnostic tool since there is no radiation. This diagnostic
tool can also be used to exclude Achilles tendinitis and/or retrocalcaneal bursitis.
Non Surgical Treatment
Treatment of Severs disease usually involves a combination of an accurate analysis of your child?s gait, muscles, tendons, ligaments and joints is a crucial first step. Specific stretching and
strengthening exercises often make up part of the treatment. Anti-inflammatory measures such as ice baths after exercise can be helpful in the short term. Footwear review, assessment and advice is
important. Orthotic devices are often needed to firstly control any abnormal traction or tension on the heel growth plate and, secondly, too unload the ground reaction forces on the heel bone.
Podiatry Care has podiatrists with specific paediatric training enabling them to utilise treatment options to relieve heel pain in children very quickly. If your child is struggling to play sport,
see a Podiatry Care podiatrist near you. In severe cases modification to activity levels may be required. Treatment of Severs disease does NOT require surgery. This foot condition responds very well
to conservative treatment.
This condition is self limiting, it will go away when the two parts of bony growth join together, this is natural. Unfortunately, Sever's disease can be very painful and limit sport activity of the
child while waiting for it to go away, so treatment is often advised to help relieve it. In a few cases of Sever's disease, the treatment is not successful and these children will be restricted in
their activity levels until the two growth areas join, usually around the age of 16 years. There are no known long term complications associated with Sever's disease.