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leciafischetti

Severs Disease Physical Rehabilitation

Overview

Sever?s disease is the most common cause of heel pain in the growing athlete and is due to overuse and repetitive microtrauma of growth plates in the heel. It occurs in children ages 7 to 15, with the majority of patients presenting between 10 and 14 years of age. Sever?s disease will go away on its own when it is used less or when the bone is through growing, but it can recur (for example, at the start of a new sports season). Traditionally, the only known cure was for children to outgrow the condition, with recurrences happening an average of 18 months before this occurs.

Causes

Growth plates, also called epiphyseal plates, occur at the end of long bones in children who are still growing. These plates are at either end of growing bones, and are the place where cartilage turns into bone. As children grow, these plates eventually become bone (a process called ossification). During a growth spurt, the bone in the heel may outpace the growth of the muscles and tendons that are attached to the heel, such as the Achilles tendon. During weight bearing, the muscles and tendons begin to tighten, which in turn puts stress on the growth plate in the heel. The heel is not very flexible, and the constant pressure on it begins to cause the symptoms of Sever?s disease. Sever?s disease is common, and it does not predispose a child to develop any other diseases or conditions in the leg, foot, or heel. It typically resolves on its own.

Symptoms

Symptoms of calcaneal apophysitis may include Pain in the back or bottom of the heel, Limping, Walking on toes, Difficulty running, jumping, or participating in usual activities or sports, Pain when the sides of the heel are squeezed.

Diagnosis

Sever?s disease is diagnosed based on a doctor?s physical examination of the lower leg, ankle, and foot. If the diagnosis is in question, the doctor may order x-rays or an MRI to determine if there are other injuries that may be causing the heel pain.

Non Surgical Treatment

Home treatment consists of calf muscle stretching exercises, heel cushions in the shoes, and/or oral anti-inflammatory medications like Tylenol or Advil. Icing the area may provide some temporary relief. If the condition persists the child should be evaluated by a podiatrist for abnormal foot function. In severe cases a below the knee walking cast may be required. Treatment may require the use of custom-made shoe inserts called orthotics. Orthotics work by correcting foot function and will fit into most normal shoes and athletic cleats.

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