Pain, Infant and Children | May 3, 2018 | Author: Naturopath
Sever’s disease is a condition where pain is experienced in the heel of the foot in physically active children. This condition is also called calcaneal apophysitis. Basically meaning 'inflammation of the heel'.
Calcaneal – Relating to the calcaneus. The calcaneus is another name for the heel bone which is a large bone that forms the foundation of the rear part of the foot.
Apophysitis – an inflammation of an outgrowth, projection, or swelling, especially a bony outgrowth (spur), that is still attached to the rest of the bone. Apophysitis occurs due to excessive traction or stress most frequently affecting the calcaneus - as seen in Sever's disease.
Sever’s disease occurs in boys more than girls between the ages of 8-15 years. It will often resolve itself in time. There are some strategies to help with symptom relief the condition.
Simply put, Sever’s disease is caused from repetitive stress to the heel. It is thought to be due to repetitive microtrauma from increased traction by the Achilles tendon on its insertion site.
This can happen from anything that involves a lot of heel movement. It can be associated with starting a new sport, or the start of a new season of sport.
Since bones and tendons are still growing in children the risk of damage is greater.
This disease is most often see in children in periods of rapid growth during which muscles and tendons become tighter as the bones become longer and larger.
Click Here For Article
Most overuse injuries in children involve the lower limbs, especially the knees, ankle and feet. The most typical are Osgood-Schlatter disease, which affects the knee, and Sever's disease; in both conditions, the tendons remain relatively short during the pubescent grown spurt.
Click Here For Article
Sever's Disease is similar to other conditions affecting the heel with diagnosis bases mostly on clinical examination. This is based on location of pain and in the absence of associated symptoms indicating a systemic disease.
Other causes of heel pain include Plantar Fasciitis, Heel Spur, Heel bump, Achilles Tendinopathy, Heel neuritis and Heel bursitis.
With Sever’s disease, there is localized tenderness and swelling at the site of insertion of the Achilles tendon.
The gastrocnemius muscle or the soleus muscle (the muscles of the calf) might also be tight. Biomechanical checks should also be done to check for abnormalities.
Management consists of modifying activity till the child is pain free. This condition usually settles within 6 – 12 months but occasionally this condition may last for up to 2 years. As with most soft tissue injuries the first concern is to settle the injury. This can be done with basic first aid of rest and ice.
Your healthcare practitioner or physiotherapist will be able to suggest the best management for Sever’ disease such as:
Magnesium is essential for the regulation of muscular contractions and is the best thing to use for muscle relaxation. Magnesium is quickly used by the body in exercise as muscles are continuously worked. Magnesium can be taken orally by children or applied to the body as an oil or cream for pain relief. Another suggestion is magnesium foot soak or bath.
Whilst there is limited information on nutrients and Sever’s Disease there is a connection with low levels of Vitamin D levels in children with growing pains.
Vitamin D is needed for many processes in the body but it’s main role is promotes normal bone formation and mineralization.
Turmeric has had many studies done as a spice beneficial in its anti-inflammatory and antioxidant actions which may be helpful for pain relief. Turmeric can be taken in powdered or liquid form and may be added to food.
Excess weight can add to heel pain. If children are reducing their exercise due to heel pain, be sure they are not exercising their mouth by chewing extra non-nutritious calories and keep the diet healthy for efficient healing.
Maintain good flexibility through stretching exercise
Wear good fitting foot wear with shock absorbing soles
Avoid activities on hard surfaces
Sever’s disease is the most common cause of heel pain in growing children and is usually managed conservatively with anti-inflammatory medications and restriction of physical activity.
Mosby's Medical Dictionary, 9th edition.
Medical Dictionary for the Health Professions and Nursing © Farlex 2012
Overuse Injuries in the Paediatric Population. https://www.ncbi.nlm.nih.gov/pubmed/27811514
Heel pain: A systematic review. https://www.ncbi.nlm.nih.gov/pubmed/26643244
Sever's disease: a common cause of paediatric heel pain https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3669931/
"Effectiveness of interventions in reducing pain and maintaining physical activity in children and adolescents with calcaneal apophysitis (Sever's disease): a systematic review". https://www.ncbi.nlm.nih.gov/pubmed/23641779
Effectiveness of footwear and foot orthoses for calcaneal apophysitis: a 12-month factorial randomised trial. https://www.ncbi.nlm.nih.gov/pubmed/26917682
Factors Associated with Pain Severity in Children with Calcaneal Apophysitis (Sever Disease). https://www.ncbi.nlm.nih.gov/pubmed/26001316
Brukner P; Khan K; 1997, Clinical Sports Medicine, McGraw-Hill Book Company, Sydney
Magnesium in Prevention and Therapy https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4586582/
Significant association among growing pains, vitamin D supplementation, and bone mineral status: results from a pilot cohort study. https://www.ncbi.nlm.nih.gov/pubmed/24633492
Vitamin D levels in children with growing pains. https://www.ncbi.nlm.nih.gov/pubmed/21575536
Mills S; Bone K, 2009, Principles and practice of Phytotherapy Modern Herbal Medicine Churchill Livingstone Australia