Sever's Disease in Adolescents | Sydney Sports Medicine Centre - Education

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Sever’s Disease in Adolescents

by Richard Windybank

Sever

What is Sever’s Disease?


Sever’s Disease occurs in active children, more often boys between the ages of 10-12, however you can see the problem as early as 8, and as late as 14 years old. It is an irritation to the growth plate in the heel bone, brought on by too much traction from the Achilles tendon. This typically happens when the leg bones start to grow faster than the muscles and tendons, causing the Achilles tendon to pull very hard at its heel insertion, which is the site of the heel bones growth plate.

The symptoms tend to be pain around the perimeter of the heel on rising in the morning, at the beginning of activity and after activity. Kids usually warm up and find it's okay, only to cool down and start running like an old man. The symptoms are self-limiting, which usually means your super star can play as much as they feel they can cope with. However it’s always advisable to reduce any incidental activity if the pain is severe.

Relationship Between Football Boots and Sever’s Disease


The reason we see so many kids this time of year with Sever’s is due to the running load being at its highest. All of this running is being done in footy boots that are traditionally flat. As the problem is driven by traction of the tendon on the heels growth plate it is only made worse when we are running in very flat shoes, as the heel has to load even more.

The answer isn’t to make your kids play footy in stilettos, but at least some heel elevation can usually help. ASICS have been making boots for several years that allow for at least 10mm heel elevation which helps to unload to tendon and the growth plate. The alternative is to try a simple heel raise in the current boots, provided they are deep enough to accommodate it.

Management


Management of the problem can range from simple to more complex. The first thing to try is calf and achilles stretches. If stretching the Achilles seems to irritate the heel, it is best to back off these and concentrate on the calf stretches.

Massaging the calf on a regular basis will definitely help the heel pain by taking tension out of the tight calf.

Icing the heel after exercise will reduce pain but can make the little champ stiff.
Heating up the heel prior to playing will often improve the symptoms, but remember when you stop you will stiffen, so keep moving at half time, don’t sit and stiffen.

Often we need to introduce more cushion to the shoes to dampen impact to the heel at the same time as elevating.

Sometimes we need to control poor foot function with the use of an orthotic.
Remember it is self-limiting, and it will resolve, but there is nothing worse than seeing your kids limping around on a weekend when they should be having fun. So have a look at those boots and think of a bit of elevation if they are showing any signs of Sever’s.

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