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Heel & Ankle Pain In Children – How can Physiotherapy and Podiatry Help?

Heel and Ankle Pain in Children: What is Severs Disease?


Common Names
Calcaneal Apophysitis | Sever’s Disease


What is Severs Disease?

Severs disease is a common condition characterised by pain around the heel bone and is usually found in active children. This pain is generally around the heel’s epiphyseal line or growth plate. The condition is known to be self-limiting, and pain is due to inflammation around the attachment of the Achilles tendon. Pain in the region ceases once ossification of the Achilles tendon occurs (James, Williams, & Haines, 2013). Pain during walking is usually standard; however, the pain increases with running and jumping, particularly during sports such as football, soccer, basketball, and gymnastics.


What is the Cause or Aetiology of Severe Disease?

Inflammation from traction and repetitive Achilles tendon strain on the heel’s growth plate typically causes pain. Inflammation and pain can generally be caused by:

  • Biomechanics of the foot and leg-pronating foot type or a high cavus foot type
  • Growth spurts – causing gastrocnemius and soleus tightness (calf muscles)
  • Muscle imbalances of the posterior hip and thigh – Trauma to the calcaneal apophysis area (heel)
  • Increased BMI


Who Does Severs Disease Effect – What is the Epidemiology?

Posterior heel pain accounts for 2%-16% of presentations to Physiotherapists and podiatrists (James et al., 2013). The condition usually presents in children and adolescents between the ages of 8-15 but has been found in children as young as six (James et al., 2013). It is common for children to report a recent growth spurt.


What is Physiotherapy & Podiatry Treatment & Management of Severs Disease?

Physiotherapy and Podiatry Treatment of Severs disease depends on the stage of the disease and the symptoms at presentation. Physiotherapy and podiatry treatment aims to educate the child and parents about what is causing their pain and how to manage it best – when some pain is tolerable and when the pain is too much and requires rest. Keeping the inflammatory factors and pain down is essential in managing these conditions, keeping the tissue tone down and load reduction on the heel.

  • Modified rest and cessation of sporting activities (decreasing duration/intensity/ frequency)
  • RICE
  • Complete immobilisation (offloading walker) if required
  • Heel lifts or cupsTaping
  • Modifying and changing footwear
  • Orthotic Therapy
  • Joint Mobilisations
  • Stretching / Foam Rolling and strengthening exercises
  • Night splints, if required
  • NSAIDs (non-steroidal anti-inflammatory medication, e.g. Nurofen)
  • Steroid injection in severe cases
  • Surgical – if the condition has been neglected, it can result in a calcaneal avulsion fracture.

Prognosis

The prognosis for this condition is usually excellent when managed correctly – children can continue sporting endeavours with minimal pain and disability. Early intervention is essential in assisting in driving this condition. The prognosis is poor when this condition is managed poorly.


If you think your child is experiencing heel pain, contact Inertia Health Group to book an appointment.


References
James, A. M., Williams, C. M., & Haines, T. P. (2013). 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, 6(1), 16. doi:10.1186/1757-1146-6-16

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