Sever’s Disease is a painful reaction in a growth plate at the back of the heel.

It reacts due to additional traction from the Achilles tendon during a significant growth spurt. It tends to affect kids between 11-14 years of age. As the pain is linked to the rapid rate of growth, most episodes only last six months.

Sever’s Disease occurs simultaneously on both sides in the vast majority of cases, although one side may be worse than the other.

TIPS

• There is no detrimental structural or anatomical change as a result of ongoing load from activity
  • This means that you can load the painful area as much as you like without worrying about long term issues
• The most effective approach is a combination of load management and pain relief
  • Load management is as easy as reducing the number and duration of sporting activities each week
    • Start by removing a session of their least enjoyable sport and see if that’s enough to reduce symptoms. If that’s ineffective, remove one additional session per week until the pain eases
  • Pain relief can be achieved with:
    • Ice after exercise, to reduce reactive soreness
    • Topical anti inflammatory gels, such as Voltaren Gel, during and after exercise
    • Heat cream, such as Dencorub, during exercise as a way of distracting from the ache
    • Heel raises in shoes, to reduce the stretch on the calf muscle
• Remember the importance of psychological factors – often your child is torn between the pain and missing out on being involved in sport with friends
  • Involve your child in the decision making process and if they’re happy to tolerate the symptoms, let them play

MYTHS

• Vigorous calf stretching is counterproductive as it adds to the pull on the growth plate from the Achilles tendon. Additionally, calf stretches don’t alter muscle length
  • To speed up the lengthening of muscle during the growth spurt, gentle strength exercises in lengthened positions are effective. An example would be a walking lunge exercise
• You DO NOT need treatment or orthotics!!!
  • This issue is a part of growing, and there are no detrimental effects if you ignore it

WHAT ELSE COULD IT BE?

• Retrocalcaneal bursitis
• Achilles tendinopathy
• Achilles tendon tear, although this is quite rare in the 11-14 years age group
• Calcaneal (heel) bone stress injury
• Posterior ankle impingement