“ um, Dad, my heels hurt!”
An all too common phrase heard by parents. With many school kids starting a new season of soccer in the last few weeks, parents often encounter complaints from their kids about general aches or pains. Whilst many of these are dismissed as such, it is often important to consider why exactly the discomfort is occurring. Whether from repetitive impact of sports or inappropriate footwear, children’s joints, muscles and ligaments are undergoing vast changes which may result in pain or irritation arising in certain parts of the body. One of the most commonly complained about region by kids, is painful heels. Whilst the cause of heel pain in kids can have a range of causes, one of the more common conditions is Severs Disease.
What is Severs Disease?
Severs disease is a common cause of heel pain in kids. This may affect kids of all ages however often will become prevalent in children reaching the age of puberty (10-12 for boys and 9-11 for girls). It affects males more so than females and research shows that physically active kids are more prone to developing this condition. Severs disease occurs when there is an imbalance between the growth rates of the leg bones (tibia and fibula) and the calf muscles. This difference results in excessively tight calf muscles and coincidently, a tight Achilles tendon which is attached to the back part of the heel. As the child continues to use the muscles through everyday activities and/or sport, the taut Achilles will constantly pull on its attachment site on the back of the heel. This in turn, results in a friction reaction which in turn causes inflammation and pain. The longer the problem persists, the more inflammation and pain accumulates.
Severs can be triggered off by physical activity such as sports or running around in the playground. This may result in overuse injuries as well which can arise from extra tension on the muscle fibres of the calf muscles which are already taut. Wearing inappropriate footwear for the child’s feet can also add extra stress on structures due to ineffective shock absorption during sport.
What are some symptoms of Severs disease?
The symptoms of Severs are fairly generalised, although when paired with a definitive patient history, a correct diagnosis can be made. Some common symptoms include but is not limited to the following:
- Pain around the heel or around the Achilles tendon.
- Pain is made worse with exercise or physical activity. The pain may be persisting during or after exercise.
- The child may be hobbling or limping. They may have a tendency to complain about heel pain.
- Preference for tip-toeing gait.
- Calf muscle stiffness and tightness.
- Warmth on surface of the heel particularly in swollen or tender areas.
What are some treatment options for Severs disease?
Being self-limiting, Severs disease often rectifies itself as the child’s body further develops and the imbalance between bone and muscle settles. In the meantime however, there are a number of steps that can be taken to alleviate the discomfort associates with the disease. These include:
- Applying ice or ice packs onto the sore parts of the heel for 10-15 minutes a day.
- Rest and/or reduced physical activity. Getting a rest from sports or physical activity can help in settling down the irritated region.
- Modification of footwear and addition of a heel raise to shorten the Achilles tendon and take some pressure off the tendon itself.
- Correcting biomechanical issues using orthotics.
- Regular stretching of calf muscles.
- Using medication to reduce pain and inflammation.
A professional assessment by a podiatrist is important in diagnosing Severs. The importance of this is further highlighted by the fact that a number of other conditions exhibit similar symptoms including plantar fasciitis, bursitis and stress fractures. A visit to the podiatrist usually yields a definitive diagnosis and may involve further referral for x-rays and ultrasounds to ascertain the exact nature and extent of damage to the soft tissue of the Achilles and the bone surface of the heel. In combination with a detailed patient history, a podiatrist is able to diagnose Severs and generate a personalised treatment protocol to get your child back on their feet pain free and happy.
Dr Anel Kapur (Podiatrist)