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Sever’s Disease (Calcaneal Apophysitis)

With fall sports in high gear, it is not uncommon for your child to experience some aches and pains on occasion.  While most non-serious injuries respond well to rest and ice, some require further intervention.

One condition that requires attention is Sever’s disease or calcaneal apophysitis.  Sever’s disease results from inflammation of the growth plate in the bone of the heel.  It commonly occurs in children during a growth spurt because the bones grow faster than the muscles and tendons.  This places greater pressure on the growth plate causing swelling, especially in active children.  Most commonly, these growth spurts occur between the ages of 8 and 13 for girls and 10 and 15 for boys.

Certain factors can put your child at an increased risk of developing calcaneal apophysitis.  Sports that involve a lot of running and jumping on hard surfaces such as basketball and gymnastics can put stress on the Achilles tendon and contribute to Sever’s disease.  However, children that do not play sports can also develop the condition.  Body type can also be a predisposing factor for Sever’s disease.  Variations in foot structure, leg length discrepancies, improper footwear and childhood obesity can all contribute to the condition.

It is easy for us to identify accidental injuries that occur on the field.  However, the ones that take time to develop may be more difficult to monitor, especially in children.  Children may not have a strongly developed sense of body awareness and may therefore ignore aches and pains until they get worse.  So, here are the things you can look for to identify Sever’s disease.  Pain, swelling and redness in the back of the heel may be your first signs.  The pain could extend to the bottom of the foot as well.  Your child may also experience difficulty walking and discomfort or stiffness in the feet after waking in the mornings.  Because children don’t always tell you about each ache and pain, keep an eye on how they are walking.  You may notice a limp or apprehension with weight bearing on the heel.  If you notice any of these things, you can investigate further by squeezing both sides of the heel for tenderness or discomfort.

Jessica Lee, PT, DPT  recommends seeing your doctor or physical therapist to discuss activity modifications if your child is experiencing any of the symptoms associated with Sever’s disease.  Depending on the severity, your child may need to limit their activity in order to prevent the condition from progressing to a more serious problem.  In most cases, through proper intervention and activity modification, calcaneal apophysitis resolves within two to eight weeks.  It some severe cases, a walking boot may be required to immobilize the ankle to allow the inflammation to resolve and the growth plate to heal.

If your child develops Sever’s disease, your physical therapist can help with modifications to their activity level as well as provide treatment to reduce the pain and inflammation associated with the condition.  Activity modification may range from small changes to their current sport to full restriction of weight bearing activities depending on the severity.  Your physical therapist can also determine if there are any underlying structural factors that may be contributing to the condition and make referrals for appropriate footwear or orthotics if necessary.  According to Jessica, proper progression of stretching and strengthening exercises is an important part of the treatment for this condition.  After any injury, it is important to regain the strength, endurance and agility required for full participation in sports before returning to the field.