Growing up fast isn’t all fun and games, It could be Sever’s Disease

iStock_000014380385XSmallOne minute, you’re holding your child in your arms, the next they are off at college. In the blink of an eye, children become adults, sometimes a little too quickly.  Children go through phases of growing, called growth spurts, which can sometimes create problems if their body isn’t in sync. Children going through growth spurts can often times feel “growing pains” if they grow too rapidly. This pain occurs because their bone grows faster than the ligaments surrounding the bone, placing heightened pressure on the tendons and ligaments supporting the bone.

Be careful to grow up too quickly:

Sever’s Disease occurs at the insertion point of the Achilles tendon and the plantar fascia at the calcaneus bone, heel bone. The calcaneus is one of the first bones to grow during puberty, causing the heel to be a common place for injury. The bone grows faster than the ligaments surrounding the heel, employing increased pressure on the Achilles tendon, and surrounding ligaments. The pressure pulls on the tendon, causing the tendon to become tight and irritated.  These micro-injuries happen repetitively during a growth spurt causing the growth plate at the back of the heel where the Achilles tendon inserts becomes inflamed and swollen. The calcaneus isn’t ossified, meaning the “heel bone” is mostly cartilage, creating a weak spot. Sports like basketball, cross-country, or soccer including substantial amounts of running increases the likelihood of this disease. Sever’s disease usually occurs in girls around ages 8-13 and boys ages 10-15.

Symptoms:

Pain is the most common symptom of Sever’s disease. The posterior or backside of heel where the Achilles tendon inserts into the growth plate will be painful, making it difficult to walk on. Pain can also spread to the bottom or sides of the foot, and will usually worsen after physical activity. The heel will most likely be tender and swollen.  The irritation usually creates a bulge at the back of the heel that is tender to the touch. The muscles in the lower leg, especially the calf muscles will be incredibly tight and most likely sore early in the morning.

Treatment:

Most cases of Sever’s disease don’t require any surgery, that being said, there is no cure for Sever’s disease either. The pain will subside at the end of the growth spurt, and the bulge will go away on its’ own. Rest is the best way to stop the pain, causing no further micro-injuries or irritation. The more physical activity you do on the injured heel, the worse the pain will become.  Ice will help to reduce the swelling, alleviating the pain and can be administered 3-4 daily. Remember to wrap the ice pack with a towel to avoid ice burns. There are remedies to decrease the amount of pain and discomfort you feel because of the disease. All of these treatment remedies should also be used in a prophylactic or preventative fashion to help eliminate the existence of pain or other future injuries. Tight muscles pull on the tendons and ligaments, causing pain. Calf stretches are an extremely good idea to help reduce the pain, and will help stretch and lengthen the muscles, decreasing the amount of tension. These are easily done standing up facing a wall, stretching both with your back leg straight and with your back leg bent. Each stretch should be held for a minimum of thirty seconds. Heel lifts will shorten the Achilles tendon, helping to reduce the amount of tension you feel. If you still want to continue physical exercise, be sure to run on a padded surface such as grass instead of concrete as much as possible. The padded surface will give support, giving more cushion to your tendons than concrete. Biking and swimming are excellent alternatives to running and place much less pressure on the lower extremities.

 

 

References:

Adirim, T.A., & Cheng, T. L. (2003). Overview of injuries in the young athlete. /Panorama des blessures du jeune athlete. Sports Medicine, 33(1), 75-81.

American College of Foot and Ankle Surgeons. (2009, December 18). Calcaneal apophysitis . Retrieved from http://www.acfas.org/Content.aspx?id=148

Conn, J. M., Annest, J. L., & Gilchrist, J. (2003). Sports and recreation related injury episodes in the us population, 1997–99. Injury Prevention9(2), 117-123. Retrieved from http://injuryprevention.bmj.com/content/9/2/117.long

Heyworth, MD, B. E. (2012). Sever’s disease. Retrieved from http://www.childrenshospital.org/az/Site3321/mainpageS3321P0.html

James et al.: “Effectiveness of interventions in reducing pain and maintaining physical activity in children and adolescents with calcaneal apophysitis (Sever’s disease): a systematic review”. Journal of Foot and Ankle Research 2013 6:16. Doi:10.1186/1757-1146-6-16

South Hampton General Hospital Paediatric Physiotherapy Department. (2011, September).Severs disease. Retrieved from http://www.uhs.nhs.uk/Media/Controlleddocuments/Patientinformation/Childhealth/Seversdisease-Patientinformation.pdf