Parents work so hard in trying to get their kids active and keep them active, so it is quite disheartening for a parent when their child complains of pain. Sever’s disease is typically seen in children between the ages of 8-15, with the majority of my patients being boys in the 9-12 age range who are very active or involved in sports. The pain is quite marked when you prod around with your fingers at the back of the heel. I see a lot of cases of Sever’s in young athletes wearing cleats where the action of the cleat digging into the ground causes a further stretch of the Achilles tendon which then pulls on the heel bone even more. Usually the pain appears to start at random and is reported as worse during activity or shortly thereafter, with rest helping alleviate symptoms. When asked to point to the area of pain, almost every patient is quick to point to the back of the heel. This disorder commonly follows a growth spurt. This is because bones tend to grow faster than the muscles and tendons of the lower limb. This growth spurt can cause the Achilles tendon to become tight, which puts extra tension on the heel bone and can lead to inflammation of the growth plate in the heel. Some cases can be chronic and if little recovery has occurred after 1-2 weeks I would recommend an assessment for further treatment. When watching a child with Sever’s walk, I quite often will see the ankles rolling inward, and the heel coming off the ground quickly. Footwear needs to be evaluated to make sure it is stable and supportive like the Asics Kayano. Even a cushioning shoe like the Asics Nimbus can make a big difference with a well-made foot orthotic to control the ankle rolling inwards. If your child has symptoms of Sever’s pull them out of their activity for a week and the rest should make it better. If they are in rep sports and the demand on their bodies is high, a physio routine and some icing will complement the orthotic and footwear therapy nicely.
Steve Lawcock, Certified Pedorthist, www.burlingtonorthotics.com