Severs

Condition

This is a condition that affects the growing part of bone called the growth plate. There is a growth plate at the back of the heel bone (calcaneus) where the Achilles tendon inserts. Disturbance at this growth plate is called Sever’s disease or calcaneal apophysitis.

What causes Sever’s disease ?

During growth, as the bones grow, the muscles and tendons have to stretch with the bone. If there is increased stress to the muscle / tendon, then it pulls at the growth plate and causes symptoms. In severe cases, the blood supply to the bone is interrupted and this can cause an area of the bone to die (avascular necrosis).

This is very common between 10-12 due to increased activity with a change of schools and growth.

Will it get worse?

Left un-treated, most musculoskeletal problems deteriorate, eventually causing reduced activity.

What are the common symptoms?

• Pain directly around the back of the heel bone. This tends to be just to the inside / outside at the back and can be underneath.
• Pain on exercise or stretching the muscle/tendon that inserts into the bone; in this case, the calf muscle group.
• Pain during sport

How is it recognised?

• Clinical examination and a detailed history allow diagnosis.
• In rare cases an x-ray or an MRI scan can help diagnosis.

What can I do to reduce the pain?

There are several things that you can do to try and relieve your symptoms:

• Rest
• Ice
• Calf and hamstring stretches
• See a podiatrist

What will Premier Podiatry do?

If simple measures do not reduce your symptoms, there are other options:

• Confirm the diagnosis / arrange any necessary investigations
• Advise appropriate shoes
• Advise exercises
• Consider prescribing orthotics. In most cases soft heel lifts are sufficient.
• In resistant cases, perform a detail 3D gait analysis to diagnose the under lying factors that may contribute to injury.

The way in which your foot loads during walking can place increased stress on the foot and this can be controlled by special shoe inserts (orthotics). Whilst these do not correct the position of your foot, they guide motion to reduce symptoms and the risk of further injury.

In many cases orthotics are only required for a short period of time to help resolve symptoms whilst function is improved with an appropriate rehabilitation plan. Our sophisticated 3D gait analysis allows us to advise patients the length of time they will require orthotics.

Will this cure the problem?

In many cases, the conservative treatments are sufficient to resolve the symptoms and prevent further damage. However, there will be a risk of recurrent symptoms with further growth, especially if the stretching exercises are stopped or activity levels become excessive.

The symptoms general settle when the growth plate fuses (i.e. growth has stopped) although there is a risk of developing problems with the tendon at the insertion.

What will happen if I leave this alone?

It is likely to get worse and affect your ability to exercise although, rest with no treatment may be sufficient to settle the symptoms.

How can I cure the deformity?

It is very rare for anyone to need surgery for this condition.