It is not unusual for children and some adults to get sore feet at times due to physical activities such as play or exercise. Children’s foot injuries are referred to as “sever disease”.
What is Sever Disease?
Sever’s disease is a bone injury which results in irritation and swelling of the heel’s growth plate. The health plate is a thin layer of cartilage near the end of the bone. This area is where most of the growth occurs, so it is weaker and is at more risk for injury. Heel pain is the most common cause of pain in children, especially for those who are active in sports regularly.
The ligaments in the legs grow slow when compared to the heel bone. The heel bone faster rate of growth causes Achilles tendons and muscles to become overstretched and tight in children when they experience growth spurts.
Tendons are ligaments and muscle fibers that are attached to bones. If these tendons are injured, they can be painful.
The heel is the first part of the body to grow to full size, and it is not flexible, making it susceptible to injury. Sever’s disease is caused by constant stress on the Achilles tendon. The constant pressure can damage the growth plate, causing pain and inflammation. The pressure and stress is a result of the following:
- Sports played hard surfaces
- Standing for a long time on hard surfaces.
- Poor-fitting shoes with no support
- Excessive exercising
Sever’s disease symptoms involve tenderness or pain in the heel, which occurs in the back of the heel and can extend to the bottom and the sides. The symptoms can cause the following difficulties:
- Limping, especially after running
- Difficulty walking
- Stiffness and discomfort
- Swelling and redness in the heel
The treatment for Sever Disease starts with controlling the pain and minimizing the inflammation, which can be accomplished with anti-inflammatory medication, lots of rest and ice. Once the inflammation and pain are under control, the implementation of orthotic intervention can address the biomedical factors. The three points of biomechanical are:
(1). Boost the contact area to reduce high-pressure points
(2). Reduce tension on the Achilles tendon by elevating the heel
(3). Correct any misalignment
The two primary strategies used by clinicians are in-shoe orthotic or strengthening and stretching programs.
In-shoe orthotic: This method is the most common for treating Sever Disease and the severs heel cups is the most common form. It can be used in conjunction with pain management exercises and stretching. The goal of In-shoe orthotic is to decrease the shear stress and correct the posture of the foot.
The orthotic devices come in many forms, such as the heel cups, insoles and heel wedges. Each device provides a different means of affecting the biomechanics of the musculature.
A severs heel cups is the most common orthotic. It compresses a pad under the heel and foot to maintain a center position and maximizes the density of the heel pad.
A Heel wedge can raise the heel position to relieve tension from a tight Achilles tendon.
Orthotic insoles provide the same purpose as heel wedges.
Orthotic devices are made of viscoelastic materials such as gel, plastics and foams. These materials are effective at absorbing shock.
Stretch and Strengthening: Strengthening and stretching programs can be active and static exercises. The programs were created to boost the ankle range of motion, to reduce strain on the Achilles tendons and stretch the soleus and gastrocnemius muscles.
It is unclear all the ways to identify risk factor for Sever disease risks. However, some risk factors include rear foot or forefoot varus, activity level, flexible forefoot and adequate footwear with support,
Obesity could be a risk factor for Sever disease as well. However, studies have not shown any definitive proof.