Does Severs Disease Need Surgical Treatment?

posted on 19 May 2015 13:13 by elanorburries
Overview

Sever?s disease is an inflammation of the growth plate in the heel, which is an area at the end of the developing bone where cartilage gradually turns into bone as kids grow. In fact, kids grow so rapidly at this age that their muscles and tendons can?t quite keep up with their feet and legs. This leaves the muscles and tendons tight and overstretched, particularly the Achilles tendon that connects the heel to the calf muscles. In fast-growing preteen and teen athletes, it can put so much pressure on the heel?s growth plate that it swells and becomes tender.

Causes

Sever?s disease is most likely to occur during the growth spurt that occurs in adolescence. For girls, growth spurts usually occurs between 8 and 13 years of age. For boys, it?s typically between 10 and 15 years of age. The back of the heel hardens and becomes stronger when it finishes growing, which is why Sever?s rarely occurs in older adolescents and teenagers.

Symptoms

This syndrome can occur unilaterally or bilaterally. The incidence of bilaterally is approximately 60%. Common signs and symptoms include posterior inferior heel pain (over the medial and lateral surface of the bone). Pain is usually absent when the child gets up in the morning. Increased pain with weight bearing, running or jumping (= activity-related pain). The area often feels stiff. The child may limp at the end of physical activity. Tenderness at the insertion of the tendons (= an avascular necrosis of the arthropathy). Limited ankle dorsiflexion range secondary to tightness of the Achilles tendon. Hard surfaces and poor-quality or worn-out athletic shoes contribute to increased symptoms. The pain gradually resolves with rest. Reliability or validity of methods used to obtain the ankle joint dorsiflexion or biomechanical malalignment data are not commented upon, thus reducing the quality of the data. Although pain and limping are mentioned as symptomatic traits, there have been no attempts to quantify the pain or its effect on the individual.

Diagnosis

Sever?s disease can be diagnosed based on your history and symptoms. Clinically, your physiotherapist will perform a "squeeze test" and some other tests to confirm the diagnosis. Some children suffer Sever?s disease even though they do less exercise than other. This indicates that it is not just training volume that is at play. Foot and leg biomechanics are a predisposing factor. The main factors thought to predispose a child to Sever?s disease include decrease ankle dorsiflexion, abnormal hind foot motion eg overpronation or supination, tight calf muscles, excessive weight-bearing activities eg running.

Non Surgical Treatment

First, your child should cut down or stop any activity that causes heel pain. Apply ice to the injured heel for 20 minutes 3 times a day. If your child has a high arch, flat feet or bowed legs, your doctor may recommend orthotics, arch supports or heel cups. Your child should never go barefoot. If your child has severe heel pain, medicines such as acetaminophen (one brand name: Tylenol) or ibuprofen (some brand names: Advil, Motrin, Nuprin) may help.

Prevention

After the painful symptoms of Sever's disease have gone away, it is important to continue stretching the heel, particularly before a vigorous exercise, and wearing good supportive shoes fitted with children's arch supports. This will prevent heel pain recurrence until the child's heel is fully developed and less prone to injury.