Sever’s Disease in young players

Sever’s Disease, also known as Calcaneal Apophysitis, is defined by a characteristic soreness and “tenderness” in the heels of growing children. It usually originates in those growing children between the ages of 9 and 14 whose bone structure is not yet fully formed and calcified. The condition is very similar to Osgood-Schlatter Disease (OSG), which occurs at the patellar tendon’s attachment point just below the kneecap on the tibial tuberosity.

Many young athletes contract Sever’s while engaged in sports practices and competitions. Sever’s can literally be the “Achilles heel” of adolescent athletes.

If unresolved it can be painful, of long duration, and may possibly have permanent detrimental effects both on the bone, as well as being a frustrating source of pain in adolescence.

What causes Sever’s Disease?

During sport, when the gastrocnemius muscle contracts, it pulls on the attachment point of the Achilles tendon, the calcaneal tuberosity of the “heel bone”. Just like OSG, where the bones grow more quickly than the muscles and tendons, the calf muscles have to catch up with the bone growth and as a result become tight. The Achilles tendon pulls repeatedly on the heel bone around the growth plate causing pain and swelling, especially if taking part in high impact activity such as running and jumping.

The injury often is associated with running and jumping activities such as soccer, basketball, track and other sports. However, it can occur suddenly in children who do not participate in organized sports. If unresolved it can be painful, of long duration, and may possibly have permanent detrimental effects both on the bone, as well as being a frustrating source of pain in adolescence.

What are the symptoms?

• The repetitive pull of the calf muscles may cause the individual to limp or walk on their toes due to the pain.
• One or both heels can be affected.
• The heel is tender if squeezed.
• There may be local swelling where the Achilles tendon meets the bone.
• The calf muscles may be tight.

How can I make it better?

Usually the pain at the heel will settle when the individual stops growing. The following may help with the pain:

• Modifying activities often helps to settle pain and swelling. If the pain is very bad, it may be helpful to avoid high impact sports that involve running and jumping until the pain decreases. Swimming and cycling are examples of low impact activities that place less stress on the joint. These types of exercise are recommended if the heel is very painful.
• The young person can continue to play sports; however, the pain may take longer to settle down. There is no evidence to suggest that playing sports causes long term damage to the structures at the heel.
• Rest often alleviates pain and allows swelling to settle.
• Once the pain has resolved, participation in physical activity and sports should be increased in a gradual manner.
• It may be helpful to ice the heel for 10 to 15 minutes, especially after physical activity and make sure the skin is protected by wrapping the ice in a towel.
• Elevate the leg after sports to allow pain and swelling to settle.
• ‘Shock absorbing’ insoles may be of benefit in shoes or trainers. Gel heel cups can be helpful in decreasing pain.
• Supportive footwear is recommended. Any activity completed in bare feet may be painful and therefore should be avoided.

Calf stretches

The following stretches are helpful in improving muscle flexibility:

Deep Calf Stretch (Soleus )

1. Position your body against a wall as shown with foot behind
2. Point toes directly toward wall and hold heel down
3. Lean into wall as shown so that you feel a stretch
4. Hold for 30 seconds, 5 repetitions, per day

Calf Stretch (Gastrocnemius)

1. Start in a step position with both legs bent.
2. Shift your weight down and forward until you feel a stretch in your calves
3. Hold for 30 seconds, 5 repetitions, per day

Advice on suitable footwear - especially footwear used for sports activities. Good supportive shoes are important for sporting activities, particularly for people who do a lot of running and/or jumping.

Applying ice to the heel - may help to reduce the heel pain.

Reducing activity - any particular activity causing the heel pain, especially any sports activity, should be stopped or reduced to allow the inflammation to resolve. This is usually only needed for a few weeks. Immobilising the lower leg and ankle in a plaster cast is occasionally needed if the pain is very severe but this is rarely needed.

Supporting the heel - temporary shoe inserts or orthotic devices may provide support for the heel. It may be helpful to obtain advice about heel supports from a GP, pharmacist or podiatrist. A podiatrist is a person who is qualified to diagnose and treat foot disorders.

Medicines - non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, can help reduce the pain and inflammation.

Sources taken from:

https://www.nuh.nhs.uk/severs-disease