SEVER'S DISEASE

What is Sever's disease?

Sever's disease occurs in children when the growing part of the heel is injured. This growing part is called the growth plate. The foot is one of the first body parts to grow to full size. This usually occurs in early puberty. During this time, bones often grow faster than muscles and tendons. As a result, muscles and tendons become tight. The heel area is less flexible. During weight-bearing activity (activity performed while standing), the tight heel tendons may put too much pressure at the back of the heel (where the Achilles tendon attaches). This can injure the heel.

Symptoms

The symptoms of Sever’s disease include:

• Heel pain.
• One or both heels may be affected.
• Heel pain during physical exercise, especially activities that require running or jumping.
• The pain is often at its worst after exercise.
• A tender swelling or bulge on the heel that is sore to touch.
• Limping.
• A tendency to tiptoe.
• Calf muscle stiffness first thing in the morning.

Risk factors

Some of the risk factors for Sever’s disease include:

• Puberty - the body grows at different rates as it progresses through puberty, and the feet are often the first body part to mature to adult size. In Sever’s disease, the growth of the heels outstrips the growth of the Achilles tendons, so soft tissue is pulled tight. This problem resolves by itself as the rest of the body catches up. By around 15 years or so, the heel has completed its growth and the associated muscles and tendons have lengthened appropriately.
• Physical activity - any form of exercise that relies on weight bearing through the legs or stressing the soft tissue can exacerbate the pain of Sever’s disease.
• External factors - for example, running on hard surfaces or wearing inappropriate shoes during sport are thought to contribute to the development of Sever’s disease.
• Overuse injury - very active children may be repeatedly but subtly injuring the bones, muscles and tendons of their feet and ankles. In time, the accumulated injuries cause symptoms.