Severs Disease

Severs disease (also known as calcaneal apophysitis) is a type of bone injury in which the growth plate in the back of the heel becomes inflamed and causes pain in children and young people. Often described as an overuse injury that can present either in one or both heels.

What causes Severs:

The cause of Severs disease is unknown.

It is linked to the Achilles tendon being tight, which causes it to pull on the growth plate (apophysis). When the muscles and tendons pull at the growth plate, the repeated motion can cause inflammation and swelling in this region, resulting in pain at the back of the heel. Muscles or tendons can become tight during a growth spurt, as bones grow faster than muscles.

Who does it affect:

• Children and young people in a growth spurt
• Children and young people involved in sports, usually those that involve running and jumping
• Boys between 10 to 15 years’ old
• Girls between 8 and 13 years’ old

Symptoms of severs can include:

• Pain or tenderness at the back of the heel on one or both sides
• Swelling and redness over the back of the heel
• Limited ankle movement such as pulling toes upwards towards shin, which can cause heel pain
• Occasional limping
• Walking on the toes

Things that can make the symptoms worse:

• Physical activities including impact sports such as; running, jumping, gymnastics, basketball, football, etc
• Poor / unsupported footwear
• Growth spurt

However, every child and young person is different

• Rest is the best treatment. Your child and young person will need to stop or cut down on sports / activities until the pain gets better.
• Ice or Pain Relief medication (please speak to your GP or local pharmacist for advice on which medication is suitable for your child or young person to take)
• Supportive shoes with laces tied up with well cushioned heel (running trainer). Avoid activities in bare feet.
• In some cases, an insole can be helpful.
• Stretching - Hold each stretch for 30 seconds and repeat 3 times. Complete stretches 3 times a day.

Calf (Gastrocnemius)

Stretching - Leaning against a wall, place one foot in front of the other foot. Keeping your back leg straight and keeping your heel on the floor, bend your front knee, until you feel a stretch in your calf
muscle.

Calf (Soleus) Stretching

Leaning against a wall, place one front in front of the other. Keeping in the same position as above, and
keeping your heels on the floor, bend both knees until you feel the stretch lower down in your calf.

Heel Dips 

Standing on the bottom step. Holding onto the handrails, stand with your toes on the step and your heels hanging off the edge of the step. Slowly drop your heels down below the edge of the step until you feel a
stretch in your calf muscle. (NHS East Lancashire, 2020)

Bottom of Foot (Plantar Fascia) Stretch 

Stand with your toes against a wall pointing upwards. Lean forwards against to wall until you feel a stretch in both your calf muscle and underneath the sole of your foot.

Hamstrings 

Sitting down with one leg extended in front of you and the other bent on the side. With the opposite hand if possible reach the foot or the ankle, keeping your lower back arched. Place the same-side hand on the floor behind you and straighten the arm. Bring the torso forward until you feel a comfortable stretch behind the thigh. Maintain and breathe normally.

Strengthening (later on, after stretching first)

Heel raises

Stand upright and raise on the tip of your toes. Lower yourself slowly back to heels on floor and repeat.

Toe curls 

Sit up straight on a chair with a towel placed under your forefoot. Slowly flex and release your toes to pull the towel towards you. Always keep the heel on the ground. Replace the towel and repeat.

Once symptoms have resolved, you can slowly begin to increase your sport/activity again.

Symptoms may recur with another growth spurt; therefore, it is recommended to continue with stretching and strengthening exercises above.

Typically, once growth has finished, symptoms do not recur.