Dealing With Severs Disease

posted on 17 May 2015 19:03 by fretfuldesperad12
Overview

A syndrome of heel pain in skeletally immature individuals. The formal name is: calcaneal apophysitis. The pain is thought to arise from the growth plate (apophysis) and epiphysis. It is thought to be an overuse phenomena. Overloading of the apophysis by both traction (due to Achilles tendon) and compression (sue to weightbearing) have been implicated. Reversible pathologic alterations occur in the apophysis, which cause secondary pain. It is the growth plate and its bone, at the back of the heel bone (calcaneus), whose presence allows for longitudinal growth of calcaneus.

Causes

Overuse and stress on the heel bone through participation in sports is a major cause of calcaneal apophysitis. The heel?s growth plate is sensitive to repeated running and pounding on hard surfaces, resulting in muscle strain and inflamed tissue. For this reason, children and adolescents involved in soccer, track, or basketball are especially vulnerable. Other potential causes of calcaneal apophysitis include obesity, a tight Achilles tendon, and biomechanical problems such as flatfoot or a high-arched foot.

Symptoms

Acute pain, pain asscoiatied with Sever?s disease is usually felt in the heel when the child engages in physical activity such as walking, jumping and or running. Highly active - children who are very active are among the most susceptible in experiencing Sever?s disease, because of the stress and tension placed on their feet.

Diagnosis

Sever disease is most often diagnosed clinically, and radiographic evaluation is believed to be unnecessary by many physicians, but if a diagnosis of calcaneal apophysitis is made without obtaining radiographs, a lesion requiring more aggressive treatment could be missed. Foot radiographs are usually normal and the radiologic identification of calcaneal apophysitis without the absence of clinical information was not reliable.

Non Surgical Treatment

Activity Modification: to decrease the pain, limiting sporting activities is essential. Cutting back on the duration, intensity, and frequency can significantly improve symptoms. Heel cord stretching is important if heel cord tightness is present. Heel cushions/cups or soft orthotics decreases the impact on the calcaneus by distributing and cushioning the weight bearing of the heel. Use of NSAIDS. Ibuprofen (Nuprin, Motrin) or naproxen (Aleve) can decrease pain and secondary swelling. Ice. Placing cold or ice packs onto the painful heel can alleviate pain. Short-leg cast. For recalcitrant symptoms a short-leg cast is occasionally used to force rest the heel.

Exercise

The following exercises are commonly prescribed to patients with Severs disease. You should discuss the suitability of these exercises with your physiotherapist prior to beginning them. Generally, they should be performed 1 - 3 times daily and only provided they do not cause or increase symptoms. Your physiotherapist can advise when it is appropriate to begin the initial exercises and eventually progress to the intermediate, advanced and other exercises. As a general rule, addition of exercises or progression to more advanced exercises should take place provided there is no increase in symptoms. Calf Stretch with Towel. Begin this stretch in long sitting with your leg to be stretched in front of you. Your knee and back should be straight and a towel or rigid band placed around your foot as demonstrated. Using your foot, ankle and the towel, bring your toes towards your head as far as you can go without pain and provided you feel no more than a mild to moderate stretch in the back of your calf, Achilles tendon or leg. Hold for 5 seconds and repeat 10 times at a mild to moderate stretch provided the exercise is pain free. Calf Stretch with Towel. Begin this exercise with a resistance band around your foot and your foot and ankle held up towards your head. Slowly move your foot and ankle down against the resistance band as far as possible and comfortable without pain, tightening your calf muscle. Very slowly return back to the starting position. Repeat 10 - 20 times provided the exercise is pain free. Once you can perform 20 repetitions consistently without pain, the exercise can be progressed by gradually increasing the resistance of the band provided there is no increase in symptoms. Bridging. Begin this exercise lying on your back in the position demonstrated. Slowly lift your bottom pushing through your feet, until your knees, hips and shoulders are in a straight line. Tighten your bottom muscles (gluteals) as you do this. Hold for 2 seconds then slowly lower your bottom back down. Repeat 10 times provided the exercise is pain free.