Aches and pains are relatively common in growing children, especially these days where it seems to be the norm for kids to play multiple different sports during the one season. Often it can be tricky for parents of younger kids, some aren’t sure if they are being completely over protective while others feel they may not be empathetic enough to their child’s complaints of musculoskeletal pain.
We see kids regularly in our practice and 90% of them are suffering from a form of ‘growing pain’ with one of the most common areas being pain around the heels. This condition is known Severs Disease.
What is Severs Disease and what are the symptoms?
Severs disease is characterised by pain where the Achilles tendon attaches onto the heel bone (calcaneus). In children who are still growing this is a soft area of the bone where the growth plate has not yet closed. During periods of growth the skeleton grows slightly faster than the soft tissues, resulting in a ‘pulling’ of muscles at their attachment sites, in this case the Achilles into the heel bone. This results in pain right at this junction between tendon and bone or in some cases higher up in the tendon.
Quite often the symptoms can occur on both sides and can include;
- Heel pain during exercise – traditionally this is increased with jumping and high velocity activities
- Increased pain or ache after exercise
- Limping or toe walking as they try to take pressure off the heal
- Localised heel pain on palpation
Factors that contribute to Severs Disease
- Growth Spurts – sometimes difficult to gauge as a parent that sees their child every day but kids tend to go through some noticeable spurts where they may jump a shoe size or shoot up a few cm in a short period.
- Physical Activity Level – Sports that involve running & jumping. Kids that play multiple sports may be at a higher risk.
- Shoes – Poor footwear choice can place extra strain on the Achilles Tendon.
- Foot Posture – tight muscles, ankle joints, foot and calf strength can all contribute.
Severs is an activity related and ‘self-limiting’ condition. For this reason parent & patient education play a very important role as the solution for Severs related pain is not to simply stop sport altogether. Relative rest, load management and activity modification will be important to reducing symptoms and improving recovery.
Potential contributing factors should be addressed by your physio such as;
- Stiff joints: in this case the two ankle joints – subtalar and talocrural should be assessed
- Tight muscles – especially the gastrocnemius & soleus muscles (aka the calf) may benefit from massage
- Muscle weakness around the ankle joint.
- Other biomechanical factors such as pelvic stability & proprioception.
Generally physiotherapy management will incorporate a strengthening and stretching program that will need to be performed on a regular basis. Your physio may also offer heel raises / inserts which can be placed inside sports shoes – these work to unload the Achilles tendon and can be a useful aid during painful periods.
Analgesic strategies such as cold packs and medication can provide short term symptomatic relief.
Sever’s Disease can be painful and quite debilitating. We think its definitely worth getting on top of early it as early as a proper diagnosis combined with correct treatment strategies can greatly assist with pain levels and performance.