Overview
It is thought to be a traction injury, where the Achilles tendon and Plantar fascia pull in opposite directions. Sever?s occurs in children aged 8 to 16 years old. In children, the heel bone is made up of 2 bones, with a growth plate of cartilage in between the sections, holding these 2 bones together. As the cartilage expands, the edges of it eventually turn to bone, and finally the gap closes. This usually occurs within the first 13-15 years of life. However, because these bones are connected by cartilage they are weaker than normal bones. This is why they are very vulnerable to injury.
Causes
Predisposing Hereditary Factors: These are a biomechanical defect that one may be born with, which increases the chances of developing Sever's Disease. Short Achilles Tendon, When the Achilles Tendon is short from birth, it will exaggerate the tightness of this tendon that occurs during a child's growing years. This makes the pull of the Achilles Tendon on the heel's growth plate more forceful than normal, causing inflammation and pain, and eventually Sever's Disease. Short Leg Syndrome, When one leg is shorter than the other, the foot on the short leg must plantar flex (the foot and toes bend down) in order to reach the ground. In this way, the body tries to equalize the length of the legs. In order for the foot to plantar flex, the Achilles Tendon must pull on the heel with greater force than if the leg was a normal length. Thus the heel on the short leg will be more susceptible to Sever's Disease during the foot's growing years. Pronation. Is a biomechanical defect of the foot that involves a rolling outward of the foot at the ankle, so that when walking, the inner side of the heel and foot bears more of the body's weight than is normal (click here for more information about pronation). Pronation thus causes the heel to be tilted or twisted. In order for the Achilles Tendon to attach to the heel, it must twist to reach its normal attachment site. This will shorten or tighten the Achilles Tendon and increase the force of its pull on the heel's growth plate. This will increase the tightness of the Achilles Tendon during the foot's growing years, and may help to initiate bouts of Sever's Disease. Flat Arches and High Arches. Both of these biomechanical foot defects effect the pitch, or angle of the heel within the foot. When the heel is not positioned normally within the foot due to the height of the arch, the Achilles Tendon's attachment to the heel is affected. This may produce a shortening or tightening of the Achilles Tendon, which increases the force of its pull on the heel's growth plate. During the foot's growing years, abnormal arch height may contribute to the onset of Sever's Disease.
Symptoms
Acute pain, pain asscoiatied with Sever?s disease is usually felt in the heel when the child engages in physical activity such as walking, jumping and or running. Highly active - children who are very active are among the most susceptible in experiencing Sever?s disease, because of the stress and tension placed on their feet.
Diagnosis
It is not difficult for a doctor to diagnose Sever's disease in a youngster or teenager. A personal history and a physical examination are usually all it takes to determine the cause of heel pain.
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.
Recovery
It may take several weeks or months for the pain to completely stop. In most cases severs disease goes away on its own with a little rest and time. However if you ignore the pain and play through it, the condition may get worse and may be more difficult to treat. When the pain is completely gone, you can slowly return to your previous level of activity. With future growth spurts the pain may return therefore keep up with the stretches and follow the advice given.
It is thought to be a traction injury, where the Achilles tendon and Plantar fascia pull in opposite directions. Sever?s occurs in children aged 8 to 16 years old. In children, the heel bone is made up of 2 bones, with a growth plate of cartilage in between the sections, holding these 2 bones together. As the cartilage expands, the edges of it eventually turn to bone, and finally the gap closes. This usually occurs within the first 13-15 years of life. However, because these bones are connected by cartilage they are weaker than normal bones. This is why they are very vulnerable to injury.
Causes
Predisposing Hereditary Factors: These are a biomechanical defect that one may be born with, which increases the chances of developing Sever's Disease. Short Achilles Tendon, When the Achilles Tendon is short from birth, it will exaggerate the tightness of this tendon that occurs during a child's growing years. This makes the pull of the Achilles Tendon on the heel's growth plate more forceful than normal, causing inflammation and pain, and eventually Sever's Disease. Short Leg Syndrome, When one leg is shorter than the other, the foot on the short leg must plantar flex (the foot and toes bend down) in order to reach the ground. In this way, the body tries to equalize the length of the legs. In order for the foot to plantar flex, the Achilles Tendon must pull on the heel with greater force than if the leg was a normal length. Thus the heel on the short leg will be more susceptible to Sever's Disease during the foot's growing years. Pronation. Is a biomechanical defect of the foot that involves a rolling outward of the foot at the ankle, so that when walking, the inner side of the heel and foot bears more of the body's weight than is normal (click here for more information about pronation). Pronation thus causes the heel to be tilted or twisted. In order for the Achilles Tendon to attach to the heel, it must twist to reach its normal attachment site. This will shorten or tighten the Achilles Tendon and increase the force of its pull on the heel's growth plate. This will increase the tightness of the Achilles Tendon during the foot's growing years, and may help to initiate bouts of Sever's Disease. Flat Arches and High Arches. Both of these biomechanical foot defects effect the pitch, or angle of the heel within the foot. When the heel is not positioned normally within the foot due to the height of the arch, the Achilles Tendon's attachment to the heel is affected. This may produce a shortening or tightening of the Achilles Tendon, which increases the force of its pull on the heel's growth plate. During the foot's growing years, abnormal arch height may contribute to the onset of Sever's Disease.
Symptoms
Acute pain, pain asscoiatied with Sever?s disease is usually felt in the heel when the child engages in physical activity such as walking, jumping and or running. Highly active - children who are very active are among the most susceptible in experiencing Sever?s disease, because of the stress and tension placed on their feet.
Diagnosis
It is not difficult for a doctor to diagnose Sever's disease in a youngster or teenager. A personal history and a physical examination are usually all it takes to determine the cause of heel pain.
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.
Recovery
It may take several weeks or months for the pain to completely stop. In most cases severs disease goes away on its own with a little rest and time. However if you ignore the pain and play through it, the condition may get worse and may be more difficult to treat. When the pain is completely gone, you can slowly return to your previous level of activity. With future growth spurts the pain may return therefore keep up with the stretches and follow the advice given.