Heel pain in Children
(Severs Disease or Calcaneal Apophysitis)
Severs disease or Calcaneal Apophysitis is a common childhood presentation characterised by painful heels, or heel during but must mostly after activity.
What is Severs disease or Calcaneal Apophysitis?
Severs disease or Calcaneal Apophysitis is a common childhood presentation characterised by painful heels, or heel during but must mostly after activity. It usually settles by the following morning which is easy way to distinguish it from an achilles tendonopathy which presents most often in the morning.
What is the cause?
The growth plate closes around 14 or 15 years of age, though I have seen the plate still open in rare cases in 16 year olds. It is often thought to be a highly active Childs problem, though we see it in all kids.
Sudden changes in walking, activity load, weight gait (in terms of natural height and muscle development) poor fitting footwear and surface change such as artificial fields and periods of drought can increase the presentation of Sever’s.
What is the treatment?
Impact, and load on the calf are targeted, i.e a combination of support and cushioning using orthoses or footwear, or both, is usually enough to allow comfortable continuation of sport. Certain strength defects, such as eccentric calf strength and endurance and gait changes are often incorporated if suspected to be contributing.
Recent studies have also shown hamstring stretching to be an effective treatment. Rapid growth spurts may also contribute.
Different footwear for different surfaces is also very effective, such as using artificial ground (AG) boots on synthetic pitches rather than typical firm ground boots (FG) boots.
Shockwave therapy is NOT recommended for this condition as per The APODA guidelines.
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