It’s fall, which means a lot of children spend many hours running around in cleats.
Soccer, field hockey, football, —whatever your sport of choice — wearing those spiky shoes often leads to heel pain. One of the most common causes of heel pain in children ages 8-12 years is Sever’s disease.
Named for James Sever, an orthopedic surgeon, this problem is medically classified as calcaneal apophysitis, translated as inflammation around the “apophysis” of the heel.
An apophysis is a growth plate which does not contribute to linear growth of a child. It serves as a point of attachment for a ligament and contributes to the shape of the bone, not the length. In Sever’s disease, the apophysis becomes irritated from repeated trauma from running long distances or from running in cleats.
Many people confuse plantar fasciitis with Sever’s disease because they both cause heel pain.
Sever’s disease vs. plantar fasciitis
Plantar fasciitis is heel pain which is typically more toward the arch of the foot and does not affect the Achilles tendon. Plantar fasciitis is more common in adults than children, but can occur in kids — especially distance runners, dancers or children who are overweight. This pain tends to be worse in the morning and decreases as the day goes on, and it has been described as “feeling like a rock in the shoe.”
Sever’s disease is more common in males and frequently occurs in both feet. Cleats are often the cause of the problem, since they center the force of running’s impact onto the heel. Arch abnormalities, such as being flat-footed, also can cause this problem or make it worse.
The main symptom of Sever’s disease is pain concentrated on the back of the heel and sometimes affecting the Achilles tendon. Pain worsens with activity, especially running.
Diagnosis can usually be made using history and physical exam. X-rays are rarely called for.
Sever’s disease typically resolves itself once growth plates begin to close. In the meantime, it can be quite debilitating for some kids and can keep them sidelined. However, there are effective interventions you can do to decrease pain and return your child to action as soon as possible.
Prevention and treatment
Dawn Cox, owner and physical therapist at Prana Functional Manual Therapy in Lancaster, feels strongly that most sports injuries, including Sever’s disease, can be prevented. She suggests that, just like you take your child to the dentist every six months, you consider taking your athlete to a skilled physical therapist who specializes in manual techniques a couple of times of year for a checkup. It is most effective if you make these prevention appointments in the off-season. Physical therapists who are trained in injury prevention can look at your child’s posture and movement on and off the field. It is not only how your child plays the sport, but how your child naturally stands, sleeps, runs or even sits to play video games that can contribute to sports injury.
In addition, Cox says, it is important to identify and treat mechanical dysfunction in the body (meaning what is “stuck” or what moves too much) prior to giving exercises or re-training posture.
“In Sever’s ... specifically, we find the the calcaneus/heel bone is completely compressed to the bone above it and not moving the way it should to absorb shock and allow for correct walking and running,” Cox says. “This causes the foot to pronate, or ‘roll in,’ putting stress to the growth plate and Achilles tendon.
“If you correct this first, the child may significantly improve in a very short time, leading to less time off the sport and no need for casting. We sometimes have kids come in on crutches, but are again running in a week or two.”
Intervention for kids who are struggling with Sever’s should include physical therapy which focuses on manipulation of the foot and ankle for better alignment and weight acceptance, retraining how the child walks or runs, balance and strengthening of the entire leg and core muscles, shoe assessment for proper cleats and regular shoes and analytics to determine problems in form and posture in every aspect of the child’s life.
Heel cups and other shoe inserts help to control pain, and may allow the child to continue participating. Cox makes the distinction, though, that orthotics do not cure the problem but merely mask it briefly. When it comes to this sports injury, only changing the way the child uses his or her feet combined with growth will make it go away.
Immobilization using a cast or a boot is a treatment of last resort for Sever’s. Orthopedic literature emphasizes that this is a temporary problem which will resolve, and that surgical interventions are not the answer.
The physiology involved in bone growth is truly a scientific wonder. Hormones, mineral levels, muscular tension and genetics all come together to make the body grow in a way that makes sense for physical activity. During this time, the growth plates are less tolerant of over-use. Taking time to straighten and align bones, strengthen muscles and learn how to move properly can make a big difference.
- Dr. Pia Fenimore, of Lancaster Pediatric Associates, answers questions about children’s health. You can submit questions at Features@LNPnews.com.