Understanding Sever’s Disease: Early Signs in Kids
Inspired by a recent patient, we’ve decided to raise awareness about Sever’s disease, an often underdiagnosed condition affecting many young athletes and active children. While it’s common for kids to experience aches and pains from physical activity, Sever’s disease, or calcaneal apophysitis, is one specific cause of heel pain that is frequently overlooked. This condition affects the growth plate of the heel bone (calcaneus) and can cause significant discomfort, especially in active children and adolescents.
In this blog post, we’ll break down what Sever’s disease is, its causes, the symptoms to look out for, and how physical therapy plays a crucial role in treatment and recovery. We’ll also share tips on preventing this painful condition, including how parents can spot early signs and take proactive steps for prevention.
What is Sever’s Disease?
Sever’s disease, medically known as calcaneal apophysitis, is a common cause of heel pain in children, especially those who are physically active. It affects the growth plate of the heel bone (calcaneus), a cartilage area where the bone is still developing. The growth plate is essential during the growth phase of childhood and adolescence, but it’s also a vulnerable area that can be easily stressed.
Unlike mature bones, the growth plate is not fully hardened and can be prone to injury, particularly during periods of rapid growth when a child’s bones, muscles, and tendons may not always grow at the same rate. This condition is most prevalent in children between the ages of 8 and 14, particularly during growth spurts.
Why It’s Important to Not Misdiagnose
Sever’s disease can often be misdiagnosed as other common conditions, such as Achilles tendonitis or plantar fasciitis, since all these conditions involve pain in or around the heel. However, unlike Achilles tendonitis or plantar fasciitis, Sever’s disease is directly caused by stress and inflammation at the growth plate rather than issues with the tendons or fascia.
Misdiagnosis can lead to improper treatment, which may delay recovery or lead to further complications. For example, an incorrect diagnosis might result in prescribing treatments like stretching exercises for the Achilles tendon, which may not address the root cause of the heel pain. Additionally, if not properly managed, Sever’s disease can lead to long-term issues such as abnormal gait, muscle imbalances, or persistent discomfort.
Because the condition primarily affects children and is often linked to the intense physical demands of sports, it’s crucial to distinguish Sever’s disease from other injuries to ensure the child receives the correct treatment. Recognizing the specific symptoms—like pain that worsens with activity, tenderness on the back or bottom of the heel, and localized swelling—can help healthcare providers make an accurate diagnosis and avoid unnecessary or ineffective treatments.
Causes and Risk Factors
Sever’s disease is typically caused by repetitive stress on the calcaneal growth plate, which leads to inflammation and pain. Some of the key factors that contribute to the development of Sever’s disease include:
- Growth Spurts: During periods of rapid growth, children’s bones grow faster than their muscles and tendons, creating additional strain on the heel. This can increase the risk of heel pain and inflammation.
- Obesity: Children who are overweight put more pressure on their feet during physical activity, which can increase the risk of developing Sever’s disease.
- Foot Arch Issues: Conditions like flat feet or high arches can alter the alignment and mechanics of walking, running, and jumping, putting additional stress on the heel.
- Increased Physical Activity: Overtraining or suddenly increasing activity levels can also contribute to the development of this condition, especially if the child’s body isn’t given time to adjust to higher intensity or frequency.
Why Activity Can Spark Symptoms
Physical activities that involve running, jumping, or sudden directional changes—such as soccer, basketball, gymnastics, or dance—put repetitive stress on the heel, which can trigger the symptoms of Sever’s disease. The repetitive pounding and pressure from these high-impact sports or exercises cause inflammation in the calcaneal growth plate. As a result, the tissue surrounding the growth plate becomes irritated, leading to pain and swelling.
During a growth spurt, the muscles and tendons in the lower leg may not stretch as quickly as the bones grow, leading to increased tension around the heel. This imbalance creates additional strain on the growth plate, making the heel more susceptible to injury, especially when combined with vigorous activity.
Symptoms and Diagnosis
The primary symptom of Sever’s disease is heel pain, which can be either unilateral (one side) or bilateral (both sides). Children may complain of pain during or after physical activities like running, jumping, or playing sports.
Other symptoms to watch for include:
- Heel Pain and Tenderness: Pain is typically located at the back or bottom of the heel and may worsen with physical activity.
- Swelling and Redness: Inflammation at the site of the growth plate can cause swelling or redness around the heel.
- Pain Worsened by Activity: The pain often becomes more noticeable after physical activity or sports.
If your child is experiencing these symptoms, it’s important to seek a professional diagnosis. Physical examination and diagnostic tests such as X-rays or MRI scans can help rule out other conditions and confirm the diagnosis of Sever’s disease.
How Physical Therapy Aids in the Process
Physical therapy plays a key role in managing and treating Sever’s disease by focusing on reducing pain, improving flexibility, strengthening muscles, and preventing future injuries. Here’s how physical therapy can help:
- Stretching and Flexibility Exercises: Targeted stretches for the calf, hamstrings, and plantar fascia reduce tension on the Achilles tendon and heel, easing discomfort and improving flexibility.
- Strengthening Exercises: Focus on strengthening calf muscles and the Achilles tendon with exercises like heel raises to help absorb shock and reduce strain on the heel.
- Biomechanical Corrections: Physical therapists assess walking/running patterns and may recommend orthotics or footwear modifications (like arch supports) to correct alignment and reduce heel stress.
- Manual Therapy: Hands-on techniques like soft tissue mobilization help alleviate tightness, improve circulation, and relieve pain in the affected area.
- Gradual Return to Activity: A phased approach helps children safely return to sports and physical activities, starting with low-impact exercises and gradually increasing intensity to avoid re-injury.
- Education and Prevention: Physical therapists educate families on proper warm-up, cool-down, and activity monitoring, empowering them to prevent future episodes of Sever’s disease.
Physical therapy is a cornerstone of treatment for Sever’s disease, as it helps manage symptoms, improve mobility, and guide a safe return to activity.
Prevention Strategies
Preventing Sever’s disease starts with educating parents and coaches on monitoring children’s activity levels and ensuring proper care. Key prevention tips include:
- Warm-Up and Cool-Down: Always include warm-up and cool-down routines with calf and Achilles tendon stretches to reduce injury risk.
- Proper Footwear: Choose shoes with adequate arch support and cushioning to minimize stress on the heels.
- Gradual Activity Increase: Avoid sudden spikes in activity. Gradually increase intensity, incorporate rest, and encourage cross-training to prevent overuse injuries.
Parents’ Guide to Early Detection
Spotting early signs of Sever’s disease is essential for preventing long-term complications and managing your child’s recovery effectively. Here’s what parents should look for:
- Complaints of Heel Pain: If your child consistently complains of pain in the heel, especially after physical activity, it could be a sign of Sever’s disease.
- Avoiding Physical Activity: Watch for changes in behavior, such as your child avoiding sports or activities they usually enjoy, due to discomfort.
- Swelling or Tenderness: If you notice swelling or tenderness at the back or bottom of the heel, it’s a red flag.
- Difficulty Walking or Running: If your child is limping or showing signs of discomfort while walking or running, it may be due to heel pain.
Early detection and intervention are key to preventing further damage and ensuring a smoother recovery process.
Get Back to Play: Twin Boro’s Approach to Sever’s Disease
Sever’s disease is a common yet often underdiagnosed condition that affects children, particularly those who are active in sports. While it can be painful, it is a manageable condition with early detection and proper treatment. By understanding the causes, symptoms, and prevention strategies, parents can help their children avoid this painful injury and ensure they get back to doing what they love.
At Twin Boro Physical Therapy, we specialize in working with patients of all ages, including children. Our team of experts provides personalized physical therapy treatments to help your child recover from Sever’s disease and prevent future injuries.
If your child is experiencing heel pain, don’t wait—schedule an appointment with us today to start their recovery journey and get them on track!
