Can Sever’s Disease Be Cured?
Yes! But it’s not a cure in the way you might think. In fact, Sever’s Disease is not really a disease in the way you might think. So don’t be alarmed if your child has been given this diagnosis. Sever’s Disease is characterised by pain in the heel of children and adolescents. The underlying pathology is known as a calcaneal apophysitis which can be broadly defined as a mechanical irritation of the growth plate of the heel bone. In short, pulling forces exerted by the achilles tendon at the attachment to the heel bone (during weightbearing activities- walking, running, jumping etc) are not always well tolerated in the region of the heel bone’s growth plate. This is because the growth plate contains a mixture of bone and cartilage tissue that is softer than the rest of the bone. The relatively soft bone of the growth plate is susceptible to a kind of low grade mechanical traction injury. It’s nothing like a broken bone, it’s more like a localised irritation that leads to localised inflammation and sensitivity that can manifest as pain with weightbearing activities.
Who Gets Sever’s Disease?
Put simply, Sever’s Disease is an overuse condition suffered by kids. If your child has this condition, it means that he/she has been loading the achilles and heel region in a manner that has outstripped his/her capacity to positively adapt to said load. In other words, your kid is training/playing too hard, too long or too often for his/her stage of growth/development. Both boys and girls are affected. The most common age range for 8-15 years of age, but really the condition could arise in a child of any age up until such time that his/her skeleton has reached maturity and the growth plate in the heel bone has closed. I can’t recall dealing with a case of Sever’s Disease where the patient (or parent) did not reveal that there had been a recent increase in performance of a specific activity. An increase for example, in frequency of dance sessions from three to five per week. Or perhaps little Jack has started playing Rugby Union as well as Rugby League… so he now trains/plays six days per week instead of three. When we start asking questions about the overall activity load of a kid who presents with Sever’s Disease, invariably there has been a ramping up of load intensity, frequency and/or duration in the preceding weeks or months.
How is it Best Treated?
By far the most important intervention is Activity Modification. We need to identify the activity that has led to the onset of symptoms, and reduce either the frequency, intensity or duration of that activity. In most cases backing off the activity load is all that needs to be done to get symptoms under control. Once things have settled, we can apply the principles of graded exposure to guide your child’s return to activity.
There are a bunch of other treatments that are commonly prescribed by Physios or other Heath Professionals. They include applying ice, stretching, wearing orthotics to correct identified biomechanical issues, or strengthening particular muscles to alter the way the foot is exposed to (and tolerates) load. My view is that these treatments are all a kind of optional add on. Most kids will do fine if we can identify the aggravating activity and back off it for a few weeks. Ice might offer some temporary modification of pain if the heel is acutely sore after activity. But it won’t matter if you choose not to ice it. Same thinking applies for stretching the foot or calf muscles. It won’t be the thing that solves the problem, but it might help with the pain a little bit. Orthotics can often bring about a reduction in pain because they do change the distribution of load through the foot. But I don’t think it’s sensible to use orthotics as substitute for appropriate activity modification. In my experience, symptoms may improve for a while but will tend to recur if the overall training volume is not reduced for an appropriate period before being gradually increased again.