What is Sever’s Disease?
Sever’s disease is a condition that causes pain in the heel of children and adolescents. While it can be quite painful, it is a self-limiting condition that doesn’t usually cause any long-term problems. Sever’s disease is quite common and is the leading cause of heel pain in children and young adolescents.
Also known as calcaneal apophysitis, Sever’s disease is an inflammation of the growth plate of the heel. A growth plate is the area of bone where new bone is produced in the growing skeleton and is often weaker than other bony areas. Repeated or excessive stress on this area can cause it to become and inflamed and painful.
What are the symptoms?
Children might complain of heel pain that is worse when walking, running or jumping. This may be present following an increase in activity or after a growth spurt. Pain may also be felt when walking on heels.
Why does this happen?
The achilles tendon attaches to the back of the heel, just next to the growth plate and puts force through this area during movement. If this force becomes too great, the growth plate can become irritated, starting a painful inflammatory process.
While increased activity is a predisposing factor, other things may also contribute, such as reduced movement of the ankle, abnormal foot movements when walking and tight calf muscles. It is also possible that Sever’s disease can appear with no obvious cause.
What is the treatment?
While this is a self-limiting disorder that will go away on its own as the skeletal system completes growth, it can be quite painful and this may impact your child’s activity levels and gait pattern.
To prevent any long-term issues from adaptations or changes in activity levels, your physiotherapist can work with your child to find solutions that allow maximum movement with minimum pain. Most of the time, simple education and relative rest or ceasing of aggravating activities are effective. Studies have also found that properly fitted orthotics can help reduce pain while maintaining activity. Physiotherapists can also address any factors which may have caused excess stress in this region, such as abnormally tight muscles or poor gait patterns. They can also advise of pain-relieving treatments and alternative forms of exercise if necessary.
None of this information is a replacement for proper medical advice. Always see a medical professional for advice on your injury.
What is it?
Plantar fasciitis is a common condition of the foot and heel affecting both athletes and members of the general public. The plantar fascia is a fibrous band of tissue that attaches to the base of the heel and supports the muscles and arch on the base of the foot. When the plantar fascia becomes chronically irritated, it is referred to as plantar fasciitis.
What are the symptoms?
Plantar fasciitis is characterised by pain at the base of the heel. It is often noticed getting up in the morning, when people take their first steps of the day. The pain may settles down after walking around, then reappear after sitting for a while and getting up again. Pain can usually be reproduced when the inside of the heel is pressed, and the calf muscles might be noticeably less flexible.
This condition can be diagnosed with a physical assessment by a physiotherapist. Left untreated, plantar fasciitis can lead to chronic heel pain, which can have a significant impact on quality of life, interfering with day to day activities.
What are the causes?
The plantar fascia supports the arch in the foot during weight-bearing and acts as a shock absorber. Small tears can appear in the fascia when it is exposed to excess tension and stress over time. While the exact cause is unknown, there are several risk factors that can increase the risk of this condition developing.
These include obesity, excessive foot pronation (or "flat feet"), inadequate shoe support, prolonged standing and excessive running. It has previously been thought that plantar fasciitis is linked to or caused by heel spurs, however this has been shown to be untrue, and many people have heel spurs without any symptoms.
How can physiotherapy help?
The goal of physiotherapy is to reduce symptoms and support the fascia to reduce and repair any tissue damage. This is done through short term pain reduction strategies such as ice, rest, activity modification and gentle stretches.
To help reduce the tension on the fascia, lower leg strengthening and balance exercises will be implemented along with orthotics and night splinting where indicated and in some cases, corticosteroid injections. A night splint can be helpful in keeping the calf muscles lengthened as they often rest in a shortened position overnight.
Other treatment options include extracorporeal shockwave therapy and endoscopic plantar release. However, these interventions will also be coupled with physiotherapy treatment for best results. Patients who are not responding to physiotherapy and other conservative management may be candidates for surgical release of the plantar fascia.