SEVER’S DISEASE

WHAT IS SEVER’S DISEASE
Sever’s disease (also known as calcaneal apophysitis) is inflammation of the heel bone growth plate, caused by excessive forces during early adolescence. It is common in physically active growing children between the age of 7 and 14 years.

Pain is often felt in the back of one or both heels and increases upon rising on tiptoes and during high impact sports that involve running/jumping. Sever’s is something that children grow out of, however pain and discomfort can be reduced so the child is more comfortable during this phase.

 

SEVER’S DISEASE CAUSES
Sever’s disease is caused by a mismatch in the growth of the calf bones relative to the calf muscles.

During a growth spurt, the heel bone grows faster than the muscles, tendons and ligaments in the leg. When the bones grow faster than the muscles, the Achilles tendon that attaches the calf muscles to the heel gets tight. It then pulls on to a weak spot on the heel (growth plate). The growth plate of the heel is cartilage that has not yet ossified (turned into bone) and thus is prone to injuries.

The pull of the tight calf muscles and the Achilles tendon to this weak spot causes a traction injury, resulting in inflammation, swelling and pain experienced in the heel.

SEVER’S DISEASE SYMPTOMS
1.) Deep ache at the back of the heel bone (which increases with activity)
2.) Swelling and redness at back of the heel
3.) Difficulty walking (i.e. limping)
4.) Change in walking pattern, (i.e. walking on tip toes to protect the heel)
5.) Calf muscle stiffness first thing in the mornings

FACTORS THAT CONTRIBUTE
1.) Tight calf muscles
2.) High levels of sport participation (Involving ballistic movements e.g. Jumping, sprinting etc.).
3.) Inappropriate footwear
4.) Incorrect foot biomechanics (e.g. Excessive pronation)
5.) Over weight

HOW WE DIAGNOSE IT

A thorough physical examination is conducted to rule out other causes of heel pain, such as Plantar Fasciitis and Achilles Tendinitis. The range of movement in the ankle is also assessed to examine calf muscle tightness. Leg length discrepancy is also examined, as a longer leg compensates for the difference in length by taking more load during walking and running, thus placing more pressure on the foot.

This is followed by a gait analysis to examine foot function while the child is walking, and in some instances running.

A footwear assessment is also conducted to ensure shoes are appropriate and have adequate shock absorption in the heel.

In some instances, a referral for an X-ray is made.

Consult now for an extremely reliable Sever’s disease treatment at Sydney Heel Pain Clinic.

ACHILLES TENDONITIS

Achilles Tendonitis Treatment

One of the challenges we face when someone presents to us with Achilles problems is they received treatment for Achilles Tendonitis when they have Achilles Tendonoses or Achilles Tendonopathy.

First, the correct diagnoses needs to be made. Second, the cause needs to be found. Third, the correct Achilles Tendonitis treatment needs to be prescribed.

Achilles Tendonitis Inflammation Vs. Degeneration

The term Achilles tendonitis should be used to refer to inflammation of the Achilles tendon. Inflammation is most often an acute change (the result of a sudden injury). This problem is characterized by swelling, redness, warmth, and pain. When seen under the microscope, inflammatory conditions have specific cells that the body brings to that area of the body to help control the inflammation and heal the injured tendon.

What is Achilles Tendinosis

Achilles Tendinosis or Achilles Tendonopathy is a very different condition that is not characterized by inflammation. Rather, these patients have thickening of the tendon. There is usually no redness or warmth of the surrounding tissue, although the area can be painful to touch. Achilles tendinosis is a chronic problem, meaning it develops gradually and lasts a long time. When seen under a microscope, inflammatory cells are not present, although chronic damage and microscopic tears of the tendon may be seen. We have seen people come to use who have been prescribed anti-inflammatory drugs which are not going to work when there is no inflammation or have been told to ice it, but it not an acute injury and does not require ice.

Achilles Tendonitis Treatment

We have a good understanding of the fundamental differences, are capable of diagnosing the condition and conduct a thorough bio-mechanical assessment to find out why it occured in the first place. Then, and only then, can we recommend a successful Achilles Tendonitis treatment.

We have a lot of success treating this condition, Achilles Tendonitis or Achilles Tendonopathy. Consult us now! Achilles Tendonitis Treatment is our expertise.

You might also want to read about Plantar Fasciitis.

If you have been diagnosed with a Heel Spur then you will mostly have an X-Ray showing it. Heel Spurs rarely cause pain, they are the result of inflammation at the site of the heel spur, most commonly caused by the Plantar Fascia (refer to Plantar Fasciitis Treatment) or the Achilles Tendon, either underneath, or at the back of the heel respectively. You can have a plantar heel spur (under the heel) or a posterior heel spur (at the back of the heel).

It is thought that the formation of the heel spur is due to the pulling and irritation on the heel bone, whereby that bone responds by growing more bone, in the direction of the pull.

Heel Spur Treatment

Heel spur treatment, regardless of location, is designed to stop the inflammation and irritation at the site. Once we know why the tendon or fascia is causing irritation to the site, we can stop the pain. We will not be looking to remove the spur, surgically or otherwise. Don’t be too concerned about the Spur itself, it’s not the problem.

You may also read about plantar fasciitis.

Case Study: Heel Pain June 2012

A 37-year-old lady presents at the clinic complaining of pain in her left heel only of approximately 18 months. She shows X rays of both feet and there are large heel spurs underneath both heels. Her heel pain is there every day, particularly in the mornings when she steps down from her bed. She confirms there is no heel pain in her right foot even though a 1cm heel spur is visible. Once again, this supports theory that the pain comes from something other than the spur.

This patient is slightly overweight and walks daily in ballet flats and on assessment has very tight calf muscles, leading to a limited range of motion in her ankle joints. In addition to feeling heel pain she describes cramping in her calf muscles, particularly at the end of the day.

Heel Pain Assessment

With the patient lying face up on the treatment table, firm pressure is applied to the medial side of the heel and the base of the heel, around the sight of pain, and in the vicinity of the heel spur. There is a positive jump response and the patient reports that the pain produced by the pressure feels the same as the heel pain that she feels daily. Patient is advised that her symptoms are consistent with Plantar Fasciitis, and that her pain is coming from inflammation within the plantar fascia, and that the heel spur is not causing the pain. She has the typical signs and symptoms of plantar fasciitis which is the most common cause of pain beneath the heel.

Bio-Mechanical Assessment for Heel Pain

Bisection lines are drawn on the patient’s feet and legs and she is observed walking and running on a treadmill. Digital data is stored and her video is replayed in slow motion. This patient does not over pronate, her feet stand up straight when she walks (and runs) but she appears to have an early heel lift. Her calf muscles are tight so that they function short and they pull the heel off the ground too early in the gait cycle. It is not uncommon to see tight calf muscles and early heel lift in patients with heel pain, in particular plantar fasciitis.

In a static, weight bearing position and with the patient in a relaxed stance position, measurements are taken of the arch height of both feet. Her readings are remarkable: 29mm on the right foot and 32mm on the left. Patient is advised that her arches are very high and that she needs supports, in order to remove the strain from the plantar fascia, and take pressure off the heel and ball of foot.

Heel Pain Treatment

  • Dry needling
  • Orthotics
  • Ice packs
  • Firm shoes
  • Calf stretching

Dry Needling for Heel Pain

Acupuncture needles are inserted using trigger point therapy along the soleus and gastrocnemius muscles. This assists in “softening” and “loosening” the muscles which in turn helps to lengthen them, and increase range at the ankle joint. The reduction in the pull of these muscles on the heel will assist recovery of the plantar fascia and will reduce the heel pain.

Orthotics for Heel Pain

Using a 3d scanner, digital images are captured of the patient’s feet as she lies face down and her foot held in an optimal position. These images will be used to make prescription orthotics which will support the arch of the foot and reduce strain on the plantar fascia. This will allow the plantar fasciitis to settle and the heel pain will stop. The orthotics will have some padding under the heel to accommodate the heel spur, but the patient understands that the heel spur is not the problem and therefore is not the focus of treatment, but the plantar fascia is.

Ice Packs for Heel Pain

The patient is advised to apply ice packs to the base of the heel every day for approximately 20 to 30 minutes. This is to reduce inflammation in the plantar fascia which will accelerate healing and also reduce the heel pain.

Firm Shoes for Heel Pain

The patient is advised that her current footwear is insufficient and that she must use shoes that are more robust, even if just for a short while until her condition has settled. She is given a list of appropriate shoes that she can shop for.

Calf Stretching for Heel Pain

This lady is shown how to stretch her calf muscles in a very specific manner, to ensure she does not irritate the heel as she stretches her calves. The dry needling that was done will facilitate this stretching process and over time her calf range will improve. This will reduce the pull on the heel and allow the plantar fascia to recover, reducing heel pain. Once again, this lady understands that the heel spur is not the problem here and her treatment programme is designed around reducing strain and inflammation on the plantar fascia, and encouraging healing of the plantar fasciitis.

More information:
Case Studies
plantar fasciitis.
How we treat heel pain

Plantar Fasciitis Video – Sydney Heel Pain Clinic | Podiatrists | Heel Pain: