Will Severs Disease Need Surgery Treatment?

Overview

Sever's disease or Calcaneal apophysitis is a condition that affects children between the ages of 10 and 13 years. It is characterized by pain in one or both heels with walking. During this phase of life, growth of the bone is taking place at a faster rate than the tendons. Hence there is a relative shortening of the heel-cord compared to the leg bones. As a result, the tension the heel-cord applies to the heel bone at its insertion is very great. Moreover, the heel cord is attached to a portion of the calcaneus (heel bone) that is still immature, consisting of a mixture of bone and growing cartilage, called the calcaneal apophysis, which is prone to injury. Compounding to this is the fact that all these changes are happening in a very active child, prone to overuse. The end result is therefore an overuse syndrome of injury and inflammation at the heel where the heel cord (Achilles Tendonitis) inserts into the heel bone (Calcaneal apophysitis).

Causes

The condition generally occurs in active children at early adolescence during rapid growth periods as the heel bone can grow faster than the leg muscles causing them to become tight and overstretched. Sever?s disease most often caused by inadequate footwear, playing sport on hard surfaces, calf tightness and biomechanical problems.

Symptoms

Pain in the bottom surface and at the back of the heel. Extreme pain when the child places their heel on the ground. The pain is aggravated when running or jumping on hard surfaces. The pain is reduced when the child walks or runs on their toes.

Diagnosis

Physical examination varies depending on the severity and length of involvement. Bilateral involvement is present in approximately 60% of cases. Most patients experience pain with deep palpation at the Achilles insertion and pain when performing active toe raises. Forced dorsiflexion of the ankle also proves uncomfortable and is relieved with passive equinus positioning. Swelling may be present but usually is mild. In long-standing cases, the child may have calcaneal enlargement.

Non Surgical Treatment

* Cold packs: Apply ice or cold packs to the back of the heels for around 15 minutes after any physical activity, including walking.

* Shoe inserts: Small heel inserts worn inside the shoes can take some of the traction pressure off the Achilles tendons. This will only be required in the short term.

* Medication: Pain-relieving medication may help in extreme cases, but should always be combined with other treatment and following consultation with your doctor).

* Anti-inflammatory creams: Also an effective management tool.

* Splinting or casting: In severe cases, it may be necessary to immobilise the lower leg using a splint or cast, but this is rare.

* Time: Generally the pain will ease in one to two weeks, although there may be flare-ups from time to time.

* Correction of any biomechanical issues: A physiotherapist can identify and discuss any biomechanical issues that may cause or worsen the condition.

* Education: Education on how to self-manage the symptoms and flare-ups of Sever?s disease is an essential part of the treatment.

Recovery

Sever?s disease is self-recovering, meaning that it will go away on its own when the foot is used less or when the bone is through growing. The condition is not expected to create any long-term disability, and expected to subside in 2-8 weeks. The disease may also take several years to stop, because it is often triggered by growing too fast. It is more common in boys, although occurs in girls as well. The average age of symptom onset is 9-11.

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