Will Severs Disease Always Need To Have Surgical Procedures?

Overview

This is a condition that is quite often misdiagnosed as growing pains this generally affects boys more than it may affects girls, especially between the ages of 9 and 15. This is a common disease in children that play the following sports. Soccer. Football. Basketball. Hockey. However it is not limited just to these sports, nor is it simply a pre-season type condition related to fitness. Sever?s Disease is common and although it does not sound good there is no need to panic as it is not something you can catch or incurable. Children have a growth plate in the heel bone, which at puberty becomes solid and forms part of the heel, prior to puberty this can cause pain especially if the child?s foot rolls inwards or outwards too much, this can cause increased stress on this growth plate and therefore causes pain.

Causes

Children are at a higher risk of developing Sever’s disease when they are in the early stages of a growth spurt. During times of growth, muscles and tendons become extremely tight. Movements during athletic activities like soccer, tennis, and gymnastics can put added force on the growth plate in the heel, which is pulled tight by the Achilles tendon. Over time, the growth plate becomes inflamed and painful. There are several other factors that can increase a child’s risk of developing Sever’s disease, including the following. Excessive pronation. Flat or high arches. Short Achilles tendon. Weight gain (which results in more force on the feet).

Symptoms

The most common symptoms of Sever?s involves pain or tenderness in one or both heels. This pain usually occurs at the back of the heel, but can also extend to the sides and bottom of the heel. A child with Sever?s may also have these common problems. Heel pain with limping, especially after running. Difficulty walking. Discomfort or stiffness in the feet upon awaking. Swelling and redness in the heel. Symptoms are usually worse during or after activity and get better with rest.

Diagnosis

To diagnose the cause of the child?s heel pain and rule out other more serious conditions, the foot and ankle surgeon obtains a thorough medical history and asks questions about recent activities. The surgeon will also examine the child?s foot and leg. X-rays are often used to evaluate the condition. Other advanced imaging studies and laboratory tests may also be ordered.

Non Surgical Treatment

Treatment for Sever?s disease is mainly supportive, to stop inflammation and reduce pain. The condition will resolve on its own when the growth in the growth plate is complete, but until then, measures can be taken to resolve pain and discomfort. Applying ice to the painful or swollen areas on the foot may provide some short-term relief from pain and prevent further inflammation. Ice can be applied for about 20 minutes two or three times a day. Footwear that is too big, too small, or does not provide proper support can exacerbate the symptoms of Sever?s disease. Supportive footwear is important to prevent discomfort, especially in children who participate in sports and activities that take place on a hard surface (such as pavement or a basketball court). Shoes should also have adequate padding and not rub against the heel. In some cases, shoes that do not have heels (such as sandals) may be more comfortable to wear while the heel is healing, but care should be taken that the shoe provides proper support to the rest of the foot. Children with Sever?s disease should avoid going barefoot.Children with flat feet, high arches, or over-pronation may need treatment to resolve these underlying conditions. In many cases, an orthotic worn inside the shoe can help put the foot into a better alignment and provide relief to the foot or the arch. Children who are overweight or obese may be counseled to lose weight. Being overweight can contribute to the development of several conditions, including Sever?s disease. Resting the foot and discontinuing sports and other activities until the pain and stiffness is resolved may be recommended. In extreme cases, a walking boot or a cast might be used to completely immobilize the foot. A physical therapist may recommend stretching exercises for the muscles in the calf and the Achilles tendon. A stretching routine is usually done several times a day. Stretching these muscles can help improve strength and decrease the stress on the heel plate. Some physicians may recommend over-the-counter pain relievers such as ibuprofen or acetaminophen. Care must be taken when administering these medications to children, especially with acetaminophen, as overdoses are possible when using more than one medication containing acetaminophen. Aspirin should never be given to children. The utility of pain relievers in children must be weighed against their possible side effects. For small variations-less than an inch or so-shoe lifts can help equalize the length of the legs. In cases with more variation between legs, surgical solutions may be considered. Research indicates that targeted manual therapy techniques performed by a licensed physical therapist can help to reduce pain from Sever?s Disease and to improve muscle function. When the larger calf muscles and the smaller ankle and foot muscles become tight, this tightness can affect the mechanics of the ankle joint. Manual therapy includes both joint and muscle release techniques to restore optimal function to the calf, ankle, and foot muscles, and results can generally be achieved within a few months.

Recovery

One of the most important things to know about Sever’s disease is that, with proper care, the condition usually goes away within 2 weeks to 2 months and does not cause any problems later in life. The sooner Sever’s disease is addressed, the quicker recovery is. Most kids can return to physical activity without any trouble once the pain and other symptoms go away. Although Sever’s disease generally heals quickly, it can recur if long-term measures are not taken to protect the heel during a child’s growing years. One of the most important is to make sure that kids wear proper shoes. Good quality, well-fitting shoes with shock-absorbent (padded) soles help to reduce pressure on the heel. The doctor may also recommend shoes with open backs, such as sandals or clogs, that do not rub on the back of the heel. Shoes that are heavy or have high heels should be avoided. Other preventive measures include continued stretching exercises and icing of the affected heel after activity.

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