Heel Pain in Growing Children: An In-Depth Look at Severs Disease

As a parent of an active child, you'll often get complaints about joint aches and pain associated with growing, and regular activity related healing, with heel pain often a recurring theme that can often be a worry and concern. This type of pain seems arise from a multitude of sources, including long periods of walking or family hikes, regular use due to sports and physical activities, and unknowingly can go beyond just growing pain to specific conditions like Sever's Disease in the blink of an eye. But as a parent, who is not in the medical field, it can be hard to effectively navigate these challenging times, and it's imperative to understand what shouldn't be ignored, how to recognize it, and what treatments are recommended to facilitate recovery. This comprehensive guide dives deep into the topic of managing, treating, and recovering from heel pain in active children, with a particular focus on Sever's Disease.

Unpacking Sever's Disease
In medical lingo, Sever’s Disease is correctly referred to as Calcaneal Traction Apophysitis. This term highlights the inflammation that occurs at the growth plate of the heel bone, where the Achilles tendon and plantar fascia are attached. This inflammation leads to a significant amount of pain and discomfort, inhibiting a child's ability to walk, run, or participate in their favorite sports or activities, and at its peak will even be sore in the mornings or after long periods of sitting and rest.

This condition is most frequently diagnosed in children between the ages of 8 and 14 who are engaged in high-impact running sports such as netball, soccer, rugby and basketball. These sports exert a lot of pressure on the feet and heels, which can lead to irritation and inflammation of the growth plate. Typically you will find that sudden increases in loading occasions will trigger these types of events, spanning anywhere from 2-6 weeks before onset. However, it's not just sports that can cause the condition. Children who spend considerable time on hard surfaces like concrete or asphalt also face a higher risk of developing Sever's Disease.

The Development of Sever's Disease: A Closer Look
The reason children are so susceptible to this condition, is that their bones are softer and less developed than adult bone, becoming more easily irritated by the pulling force of the Plantar Fascia or Achilles Tendon. This tension triggers unwarranted timing of bone remodeling, reducing the bone's capacity to deal with tension and compression loads. 

A child's growth spurts can also contribute to the development of the condition, however, it's important to differentiate between "growing pains," a common part of growing up, and Sever's Disease, a medical condition that requires prompt attention. If not addressed, the condition can lead to severe pain, alteration of bone integrity and microfractures of bone. Mostly though, as the disease will rely largely on time for healing, it impacts on your child's ability to play, engage with friends and family and impact on quality of life at a young age.

While it may be challenging to prevent the onset of Sever's Disease entirely, there are proactive measures parents can take to minimize its progression. These steps include encouraging periods of rest, discouraging overuse of the affected area, and exploring therapeutic interventions like custom orthotics or the use of bracing like the Sever’s Sleeve to reduce tension and load pressure on the growth plate.

Spotting the Symptoms of Sever's Disease
There are several symptoms associated with Sever's Disease that parents should watch out for:

  • Persistent and recurrent heel pain during and post physical activity - even into the night of and next day
  • Altered gait (walking patterns), such as limping or toe-walking
  • Pain localized to the back or bottom of the heel, which may intensify upon waking
  • Signs of inflammation such as swelling, redness, or tenderness in the affected area

These symptoms in combination, along with a timeframe of 2-6 weeks of being present, should not be overlooked, and a healthcare professional should be consulted promptly. While Sever's Disease is not immediately serious, if left untreated, can be very debilitating and impactful to your child's quality of life.

Treating and Rehabilitating Sever's Disease: A Multi-Pronged Approach
Effective management, treatment, and rehabilitation of Sever's Disease are fundamental to ensuring a safe and full recovery for your child. 

Initial treatment typically involves a period of rest and activity reduction to offload the foot and minimize aggravation. Using crutches and taping strategies can be beneficial as they offer a mechanical way to offload the growth plate and lessen the inflammatory process. However, rest alone is not a comprehensive treatment for Sever's Disease. Short bouts of complete rest followed by an abrupt return to exercise will likely result in recurrence of Sever's Disease. Therefore, diligently following a proper rehabilitation program is crucial for a successful and sustained recovery.

Incorporating manual therapy such as massage and dry needling, along with a progressive strength exercise regimes targeting the Achilles tendon, are crucial for an expedited recovery. The introduction of the Sever’s Sleeve brace, which consistently offloads the growth plate, encourages normal walking and allows earlier restoration of function when worn, will also contribute to a quicker recovery.

Monitoring your child's transition back to progressive exercise is equally important to avoid reaggravation's or exacerbation of the condition. Objective testing can help determine when it's safe for your child to return to their sports and activities, and should be done under the guidance of a healthcare professional.

The Role of Braces in Treating Sever's Disease
The Sever’s Sleeve is a highly effective tool that can be used initially for about 1-2 hours on the first day, then adding an hour of use per day after that until the full time required is reached. This brace works by offloading the growth plate, reducing pain, and fostering functional movement and recovery. Always seek professional advice when using the Sever's Sleeve and ensure you follow a tailored program in conjunction to enhance the injured tissue's capacity on complete recovery.

Overcoming Sever's Disease is a process that requires understanding, patience, and the right approach. With the guidance provided in this comprehensive blog, we hope to empower parents with the knowledge and tools needed to support their child through this challenging journey. For more personalized assistance or to schedule a private consultation, feel free to reach out to our team at any time.

From Pain to Performance

The Orthopaedic Sleeve Society (TOSS)

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