August 30th, 2011
It's Fall!
Well, technically fall won't start for another 3 weeks but sports activities are underway for youth of all ages for the fall season.
With this increased athletic activity comes the increased stresses on the small bodies of of our children and one of the more common diagnoses I am seeing in pediatric referrals is something called Sever's Disease or Calcaneal Apophysitis.
What is it?
Sever's Disease is a growth plate disorder in the heels of the athletic pre-adolescents and adolescents (usually boys, although I am seeing the frequency of girls rise) that causes pain in the back of the heel when walking, running, jumping and even with passive stretching of the Achilles tendon. [1]
The heel of the growing child contains a growth plate, or physis, that runs roughly diagonally from the top, back of the heel, where the Achilles tendon attaches, to the front, bottom of the heel where the plantar fascia attaches. It is the tissue within this growth plate that becomes inflamed as it is pulled and tugged by the repetative stresses of sport activity and in my practice is almost always accompanied by a foot that over-pronates.
Where does it hurt?
Sever's disease causes pain and tenderness on the back of the heel and is most sensitive when walking uphill, during the quick start & stop running or cutting in sports such as soccer or football and in jumping sports like basketball or volleyball. All of these activities use the Achilles tendon to pull the heel back and up placing strain on the growth plate.
What can be done to help?
Visit a sports orthopedist or podiatrist to verify the diagnosis. Pediatric heel pain is not treated in exactly the same ways as adult heel pain since we are dealing with a growing, not fully developed foot. We have to be sure of the problem to create a treatment plan that will be a success.
Limit the physical activity and get your child to rest and allow the inflammation to go down. Talk to your doctor to find out which anti-inflammatory medicine might be of use. This is not the time to go with the 'no pain, no gain' approach. Cutting out the athletic activity completely may not be necessary but pay attention to the symptoms and let the frequency and intensity of the symptom help determine how much to rest or participate.
Have your child fitted for a pediatric orthotic shoe insert. These inserts usually have deep heel cups and high sides to control his the foot's motion and maintain pronation control that is absent with the shoe alone. These can be custom (casted with plaster to make a model fo the foot) or semi-custom (heat molded dorectly to the childs foot). I have had great success with the Heat Mold UCB I use here at InStep.
Replace shoes that are too flexible or worn out. If you can bend your child's shoe in half in the middle, where the arch is, the shoe is too flexible for sporting activity. Ideally a stiffer court shoe or shanked turf shoe will pair with an orthotic to give better support and reduce the stresses on the heel. This may not be possible in all activities that place great strain on the foot. For example, en pointe ballet or jazz dancing 'shoes' are more-or-less simply coverings for the foot. In this case, rest may be the only real option.
How long does it last?
Honestly, this will vary with the skeletal and muscular development of each child. I have seen children who resolve to a pain free state in as little as 4 weeks with use of a proper shoes and orthotic insert, to children that do not resolve completely for 6 months or more. Just remember, this is a growth and skeletal matuation related issue and once the growth plate in the heel is fully hardened, the condition is over and will not reoccur.
{The information presented here is for informational purposes only and is in no way intended to replace the medical advice of your doctor. If you have experienced discomfort in your feet that has lasted for longer than 2 weeks, seek the advice of a Podiatrist or Orthopedist.}
[1] Alexander, Ian J.: The Foot - Eamination & Diagnosis, 2nd ed., Churchill Livingstone Inc., 1997
Stephen Sadler, C.Ped., BOC-Pedorthist
Board Certified Pedorthist
InStep the Birkenstock Store, Austin, TX