Severs Disease Physical Therapy

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Overview
Sever's Disease, otherwise known as calcaneal apophysitis is an inflammation of the growth plate in the heel of growing children, typically adolescents. The condition presents as pain in the heel and is caused by repetitive stress to the heel and is thus particularly common in active children. It usually resolves once the bone has completed growth or activity is lessened.

Causes
The pain of Severs usually occurs because of inflammation and micro-trauma to the growth plate of the heel bone. This can be caused by a sudden increase in activity, running on very hard surfaces, a growth spurt, tight muscles or feet that roll in.

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
Low-grade inflammation of the calcaneal apophysis cannot be seen on x-ray. Therefore, although x-rays are often done to rule out bony injuries in children with Sever's disease these x-rays are usually normal. Advanced Sever's disease can be seen on x-ray but usually the problem is treated before it reaches this point. Other diagnostic tests, such as bone scans or MRI's, are not usually required in typical cases of Sever's disease. These, or other tests, may be required to rule out other conditions, such as stress fractures of the calcaneus or other bony abnormalities that can mimic Severs disease.

Non Surgical Treatment
If the problem is bad enough, it is important to totally rest the symptomatic foot. Take a break from sport activity until the pain has significant improvement. Severe cases will need to be treated with a cast boot. Anti-inflammatory treatments include Icing, Over-the-counter anti-inflammatory medicine as recommended by your pediatrician or podiatrist. Shock absorption and support. Don't go barefoot at home, wear some type of good sandal or shoe. A significant and/or chronic case should be treated with prescription orthotics. This addresses mechanical problems that cause this problem, Using an over-the-counter heel cushion inside of the shoe, Athletic foot taping, Stretching. Runners stretch to stretch out the calf muscle. A night splint will also help. Severe or chronic cases respond best to prescription orthotics with specific modifications for this problem. May require a night splint. Daytime braces that may also help.

Surgical Treatment
The surgeon may select one or more of the following options to treat calcaneal apophysitis. Reduce activity. The child needs to reduce or stop any activity that causes pain. Support the heel. Temporary shoe inserts or custom orthotic devices may provide support for the heel. Medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, help reduce the pain and inflammation. Physical therapy. Stretching or physical therapy modalities are sometimes used to promote healing of the inflamed issue. Immobilization. In some severe cases of pediatric heel pain, a cast may be used to promote healing while keeping the foot and ankle totally immobile. Often heel pain in children returns after it has been treated because the heel bone is still growing. Recurrence of heel pain may be a sign of calcaneal apophysitis, or it may indicate a different problem. If your child has a repeat bout of heel pain, be sure to make an appointment with your foot and ankle surgeon.


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Severs Disease Physical Therapy

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