Sever’s Disease

Sever’s disease is when the growth plate of the heel bone becomes irritated and inflamed.

Sever’s disease is an overuse unjust in the heel bone calcaneus. It happens as the foot grows and causes pain in the heel with weight bearing and walking on hard surfaces.

Causes

Sever’s disease is caused by overuse and excessive running and jumping, especially between the ages of 8–13. Factors that can cause Sever’s disease to become worse are:​

• Sports with running or jumping on hard surfaces
• Standing too long
• Inappropriate footwear, such as shoes without enough support
• Overuse or too much exercising during growth spurts
• Inadequate warm up and cool down stretching

Symptoms

Common symptoms related to Sever’s disease are:

• Pain at the back of the heel
• Pain that radiates to the sides and bottom of the foot
• Limping, especially during running or jumping
• Difficulty walking
• Swelling or redness in the heel
• Preference for soft shoes and reluctance to walk barefoot

Diagnosis

To determine if your child has Sever’s disease, our specialists will perform a physical exam that may include flexibility tests, stress tests, muscle tests and gait analysis. These additional tests will help our specialized team better understand your child’s condition, assess range of motion and identify abnormalities that might occur in bone alignment or muscle function.

After a physical exam, our specialists may also order imaging tests such as an X-ray.

Treatment

Initial treatment can be remembered by the acronym, LUSKIN:

Relative Rest
If patient is limping when running or walking, patient should rest from sports until they are no longer limping.

Heel Cup
A heel cup can be used to ease the discomfort while walking. Heel cups can be purchased at most sporting goods stores, online, and at most pharmacies.

Icing
Ice the heel several times a day to reduce swelling and pain after activities.

Stretching
A program for stretching the calf muscles (gastrocnemius and soleus).

A Walking Cast
May be used for approximately 3-4 weeks in severe cases and when stretching, icing, and heel cups don’t help.

Towel Stretch
Sit on a hard surface with your injured leg stretched out in front of you. Loop a towel around the ball of your foot, and pull the towel toward your body. Be sure to keep your knee straight. Hold this position for thirty seconds and repeat three times.

Standing Calf Stretch
Facing a wall, put your hands against the wall at about eye level. Keep the uninjured leg forward and your injured leg back about 12-18 inches behind your uninjured leg. Keep your injured leg straight and your heel on the floor and keep your toes pointed towards the wall. Next, do a slight lunge by bending the knee of the forward leg. Lean into the wall until you feel a stretch in your calf muscle. Hold this position for 30-60 seconds, and repeat 3 times.

Half Kneeling Ankle Mobility
Start by placing the knee of the uninvolved leg down on the floor and the involved leg out in front of your body so you are in a 90 degree lunge. Your knee should be stacked on top of your ankle. Keeping your foot/heel flat on the floor, slowly shift your hips forward so that your knee moves over your toes, deepening your lunge. Hold for 5-10 seconds. Press your hips back to starting position. Repeat for 3 sets of 10 repetitions. Try to press your knee further out over your toes with each repetition.

Hamstring Stretch
Lie on your back and bring affected leg towards your chest. Grab the back of your thigh and try to extend your leg. Hold this position for 30 to 60 seconds, feeling a stretch in the back of your thigh. Repeat three times. You may also try this with a towel around your foot if it is more comfortable.

Resisted Dorsiflexion
Sitting with your leg out straight and your foot near a door, wrap the tubing around the ball of your foot. Anchor the other end of the tubing to the door by tying a knot in the tubing, slipping it between the door and the frame, and closing the door, or have a friend or family member hold the band for you. Pull your toes toward your face. Return slowly to the starting position. Repeat 10 times, and do 3 sets of 10.

Resisted Plantar Flexion
Sitting with your leg outstretched, loop the middle section of the tubing around the ball of your foot. Hold the ends of the tubing in both hands. Gently press the ball of your foot down, and point your toes, stretching the THERA-BAND. Return to the starting position. Repeat 10 times, and do 3 sets of 10.

Resisted Inversion
Sit with your legs straight out and cross your uninjured leg over your injured ankle. Wrap the tubing around the ball of your injured foot and then loop it around your uninjured foot so that the THERA-BAND is anchored at one end. Hold the other end of the THERA-BAND in your hand. Turn your injured foot inward and upward. This will stretch the tubing. Return to the starting position. Repeat 10 times, and do 3 sets of 10.

Resisted Eversion
Sitting with both legs outstretched and the tubing looped around both feet, slowly turn your injured foot upward and outward. Hold this position for 5 seconds. Repeat 10 times, and do 3 sets of 10.

Towel Pick Up
While sitting in a chair with your heel on the ground, pick up a towel with your toes. Release. Repeat 10 to 20 times. When this gets easy, add more resistance by placing a book or small weight on the towel.

Seated Arch Squeeze
Place a chair next to your non-injured leg and stand upright. The chair will provide you with balance if needed. Stand on your injured foot. Try to raise the arch of your foot while keeping your toes on the floor. Try to maintain this position and balance on your injured side for 30 seconds. This exercise can be made more difficult by doing it on a piece of foam or a pillow, or with your eyes closed.

At-Home Care

Common at-home treatment options for Sever’s disease include:

• Icing the Area: Put ice packs wrapped in a towel or thin cloth on your child’s foot for 20–30 minutes every 3-4 hours for the first 2-3 days. If pain does not go away, contact your healthcare provider.
• Elevating the Injured Foot: Elevate your child’s foot by placing it on a pillow when your child is lying down. Elevating it above the heart level can help reduce swelling and pain.
• Taking Non-Prescription Medication: Take a non-steroidal, anti-inflammatory drug (NSAID), such as ibuprofen as recommended by your healthcare provider.
• Exercising: Your doctor may recommend doing exercises at home. These are designed to stretch the affected foot, maintain range of motion in the joint and strengthen your child’s foot.

Prevention

• While your child is growing, have them perform exercises that stretch the foot and ankle.
• Make sure your child does proper warm up and cool down stretches when exercising.
• Make sure all your child’s shoes have good cushion and support.