Sever’s Disease
What is it?
Sever’s disease or ‘calcaneal apophysitis’ is a common cause of heel pain in young athletes. This occurs when repetitive microtrauma causes irritation of the calcaneal (heel) growth plate. The general consensus is that repetitive traction forces applied to this area by the achilles tendon causes trauma, resulting in heel pain.
This condition tends to affect those in a significant growth period (most commonly ages 7-15), where the growth plate has not yet transitioned from cartilage to bone. The growth plate may be more susceptible to irritation during this period because:
- It will be highly sensitive to load change
- Skeletal development may exceed muscular development and result in higher traction forces (tight calf muscles acting on longer bones)
- Motor control may not have developed sufficiently to control the growing body efficiently
- Kids are so active! With involvement in multiple sports often not allowing adequate time for rest and recovering
Symptoms commonly associated with severs disease
SYMPTOMS MAY INCLUDE:
- Pain at the back of the heel
- Pain that is activity related, often increasing with weight bearing, running or jumping
- The ankle joint may feel stiff
- A limp may observed following physical activity (or during)
- Tenderness at the insertion of the Achilles tendon
- Hard surfaces and less supportive footwear may result in more soreness
- The pain gradually resolves with rest
Contributing Factors associated with severs disease
There are many factors that can contribute to the development of severs disease, these may include (but are not limited to):
MODIFIABLE
- Muscle length (gastrocnemius/soleus)
- Foot posture (arch height and rearfoot pronation)
- Deficits in strength or control
- Inadequate proprioception
- Ankle instability/laxity
- Reduced dorsiflexion range of motion
- Midfoot joint stiffness
- Gait or loading mechanics
- Proximal strength and control
- Fatigue
- Total activity load
- Recent change in activity/load
- Sport
- Surface
- Footwear and external supports (brace/tape)
- Poor rehabilitation from prior injury
- Inadequate warm up
NON-MODIFIABLE
- Age (state of growth plate)
- Gender
- Previous injury
- Individual anatomical variations
Considerations in the management of severs disease
SHORT TERM
DIAGNOSE
Diagnosis is a vital part of managing any injury. Not only is it important to determine which structures are responsible for your symptoms, but why they have become symptomatic. Addressing the ‘why’ will ensure adequate recovery and prevention of future injury.
REHABILITATION
A rehabilitation program that targets the key contributing factors will fast track your return to pain free activity, and prevent future injuries.
SOFT TISSUE TECHNIQUES AND DRY NEEDLING
These techniques may be beneficial in addressing muscle function, joint position and symptoms
FOOTWEAR
Your physio will determine if footwear is a contributing factor, and may work with other health professionals such as podiatrists to make changes if necessary. Taping techniques or heel lifts may also provide symptomatic relief in the short term.
REST AND LOAD MANAGEMENT
Initial rest from aggravating factors is important to reduce the inflammatory response of affected tissues. Your physio will guide your return to sport/activity to limit aggravation that can slow the rehab process.
LONG TERM
STRENGTHENING
A strengthening program under the guidance of physiotherapists and/or strength and conditioning coaches may be recommended to help address contributing factors such as calf strength and lower limb biomechanics
SUMMARY
If you have any questions about severs disease or heel pain, please do not hesitate to contact us on (03) 5229 3911, email us at info@theinjuryclinic.com.au or book an appointment to see one of our physiotherapists in Geelong.
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