During AGS, and in specific reference to Sever?s disease, the heel bone grows faster than the Achilles tendon, resulting in an extremely tight Achilles tendon. Because the foot is one of the first
parts of the body to grow to full size, and because the heel is not a very flexible area, it is especially susceptible to injury. The Achilles tendon (also called the heel cord) is the strongest
tendon that attaches to the growth plate in the heel. Over time, repeated stress (such as impact activities) on the tight Achilles tendon causes the tendon to pull on and damage the growth plate in
the heel, resulting in swelling, tenderness, and pain.
There are many contributing factors that cause strain across the growth plate, making your child prone to developing Sever?s disease. These include repeated minor trauma to the growth plate from
running or jumping sports, tight calf or hamstring muscles, rapid growth spurts can lead to the leg muscles becoming tight, increasing tension on the growth plate, tight Achilles tendon, the Achilles
tendon attaches to the back of the heel adjacent to the growth plate, poor foot posture, may increase the strain on the growth plate, footwear with a very low heel pitch (eg soccer boots),
unsupportive or unstable footwear with poor shock absorption at the heel, running or playing sport on hard surfaces.
The main symptom of sever's disease is pain and tenderness at the back of the heel which is made worse with physical activity. Tenderness will be felt especially if you press in or give the back of
the heel a squeeze from the sides. There may be a lump over the painful area. Another sign is tight calf muscles resulting with reduced range of motion at the ankle. Pain may go away after a period
of rest from sporting activities only to return when the young person goes back to training.
Sever condition is diagnosed by detecting the characteristic symptoms and signs above in the older children, particularly boys between 8 and 15 years of age. Sometimes X-ray testing can be helpful as
it can occasionally demonstrate irregularity of the calcaneus bone at the point where the Achilles tendon attaches.
Non Surgical Treatment
Treatment depends on the severity of the condition, but may include relative rest and modified activity, a physiotherapist can help work out what, and how much, activity to undertake. Cold packs,
apply ice or cold packs to the back of the heels for around 15 minutes after any physical activity, including walking. Shoe inserts, small heel inserts worn inside the shoes can take some of the
traction pressure off the Achilles tendons. This will only be required in the short term. Medication, pain-relieving medication may help in extreme cases, but should always be combined with other
treatment and following consultation with your doctor). Anti-inflammatory creams are also an effective management tool. Splinting or casting, in severe cases, it may be necessary to immobilise the
lower leg using a splint or cast, but this is rare. Time, generally the pain will ease in one to two weeks, although there may be flare-ups from time to time. Correction of any biomechanical issues,
a physiotherapist can identify and discuss any biomechanical issues that may cause or worsen the condition. Education on how to self-manage the symptoms and flare-ups of Sever?s disease is an
essential part of the treatment.
Once your child?s growth spurt ends, and she's reached full size, her Sever?s disease won?t return. Until then, the condition can happen again if your child stays very active. Some simple steps can
help prevent it. Have your child. Wear supportive, shock-absorbing shoes. Stretch her calves, heels, and hamstrings. Not overdo it. Warn against over-training, and suggest plenty of rest, especially
if she begins to feel pain in her heel. Try to avoid lots of running and pounding on hard surfaces. If she?s overweight, help her lose those extra pounds, which can increase pressure on her heels.