Sever's Disease 

GENERAL SEVER'S INFORMATION FROM THE L.E.G. TEAM

Sever’s Heel Pain - What is it?


Sever’s Heel Pain is a common childhood injury where the heel growth plate is sore and inflamed. It is commonly referred to as a growing pain of the heel. And this is correct. If you look at the Xray below, the yellow arrow is pointing to a heel bone and more correctly a growth plate. This heel growth plate the Sever’s heel pain area. Growth plates are prevalent in the human body when the child is growing and this put simply is how our bones elongates and we get bigger. Sever’s was first described in the medical literature by Warren Sever in 1912. It is also referred to as Calcaneal Apophysitis or even Sever's Disease - We think using the term “Sever’s Heel Pain” is much easier!!




Sever’s Heel Pain - Some simple facts:


Sever’s heel pain is the number 1 childhood heel pain complaint Sever's is most common in children aged between 9 and 14. Often Sever’s can be a direct result of increased athletic behaviours or overload of sports training. Sever’s is quite painful during and after sports and the child may be seen visibly limping or running without pushing off. Some days will be better than others - and this is usually dependant on how much sports activity (load) the child has been involved in recently.




Sever’s Heel Pain - Why does my child have Sever’s all of a sudden?


More than likely your chlid is growing if they have Sever's heel pain. ​Pain in the heel growth plate is normally caused from the over working of the Achilles and plantar foot muscles pulling in opposite directions to one another creating a traction load on the growth plate (indicated in the pic below) ​At the ages of 8-12 this growth plate is particularly sensitive as it is trying to become adult bone but with the tug of ware created between the Achilles and the plantar foot muscles it becomes sore and inflamed.​ At our private clinic in Australia we see Sever’s heel pain all year round but we think it is particularly prevalent during the school year and especially correlated with the onset of new athletic activity. ​​If you need more information or would like a consultation please click here and we can organise one for you or your child right away. These consults can be done in clinic or online via our state of the art software that runs our business and rehab programs.​ Also, just so you know we offer a 4 week online program for your child. This program is amazing!!! The exact rehab you will learn about in this hub is delivered right to your smart device in video format each day. It will guide your child through the exact exercises you need to perform to enable you to successfully manage your chlids Sever's Heel Pain.




Sever’s Heel Pain - How to successfully manage the treatment of Sever's Heel Pain in children?


How we manage Sever's pain in our clinic and online!​​​ Managing Sever’s heel pain is actually very easy. But there are NO MAGIC CURES!! The successful management of sever’s involves a solid plan that can be executed by your child on a daily basis. It is essential to have a plan for keeping the heel “warmed up” even sports breaks like time outs or during half times. Most children will limp visibly if the heel is not “warmed up” It is the placation of a successful plan which is inclusive of the elements aged above that leads to your child continuing to participate int he sport they love with less pain. Using our online Sever’s rehab program via our futuristic app. The main way we help children from all over the world manage their Sever’s heel pain is via our easy to use mobile application that we have partnered with . In your program you are instructed on the various exercises each day with videos . These videos are a matrix of stretching exercises, strengthening exercises, massage and management techniques. They are easy to understand and tailored so that your child can perform them at home. You will have the option each day to record the amount of exercises that you perform and the software will instruct you of the recommended amount. You can also record your comfort levels during the exercise If you need more information or would like a consultation please click below and we can organise one for you or your child right away. These consults can be done in clinic or online via our state of the art software that runs our business and rehab programs. Also, just so you know we offer a 4 week online program for your child. This program is amazing!!! The exact rehab you will learn about in the remainder of this course is delivered right to your smart device in video format each day. It will guide your child through the exact exercises you will learn about in this course and enable you to successfully manage your chlids Sever's Heel Pain. Also, just so you know we offer a 4 week online program for your child. This program is amazing!!! The exact rehab you will learn about in this hub is delivered right to your smart device in video format each day. It will guide your child through the exact exercises you need to perform to enable you to successfully manage your chlids Sever's Heel Pain.





TOP TIPS FOR PARENTS DEALING WITH THEIR CHILDS SEVER'S PAIN

TOP TIP 1 FOR PARENTS DEALING WITH THEIR CHILDS SEVER'S PAIN


Managing Sever’s heel pain in your child is actually very easy. But there are NO MAGIC CURES!! No one off miracles that magically fix their pain!!! TOP Tip #1: USE AN EVIDENCE BASED TREATMENT PLAN It may not seem obvious, but you are guessing at what to do until you have a solid management program that contains exactly what your child is required to do each and every day to help their Sever's Heel Pain. This is the most important step without a plan you are flying blind as to how to treat Sever's Heel pain. Current research is indicates that we must base our treatment for this condition off similar protocols to those used for the treatment of tendinopathies in the human body. Our LEG rehab plans involve a lot of research based evidence that supports the use of the therapeutic modalities we will instruct your child on in our rehab program.




TOP TIP 2 FOR PARENTS DEALING WITH THEIR CHILDS SEVER'S PAIN


TOP Tip #2: YOUR PLAN NEEDS TO BE SIMPLE AND ACHIEVABLE Once you have a solid plan of attack for how to treat and manage this Sever's Heel Pain Next, your plan needs to be simple enough for a 8-12 year old to understand, achieve and execute This means that the exercises need to be simple and they must be able to be done by children and they need to know why they are doing these things to help their heel pain. I have seen other therapists plans which have the child doing literally 20 minutes of calf stretches and nothing else. These old plans are no longer evidence based. Check out our rehab guide now




TOP TIP 3 FOR PARENTS DEALING WITH THEIR CHILDS SEVER'S PAIN


TOP Tip #3: SEVER'S TREATMENT NEED TO BE DONE DAILY Sever's Heel pain is sometimes worse during rest periods and just at beginning of sports and their training as well as after sports. Management of pain during sports activities is very possible. Research conducted into Sever's Heel pain in children currently suggests that Sever's Heel pain can be treated regularly and it should be. There are pain relieving exercises such as the exercises in our Sever's Rehab guide can and should be done during painful times. These can be performed easily multiple times per day. Our online rehabilitation guides can show your child these particular exercises and how to perform them. This will not "magic cure" or "QUICK FIX" the entire Sever's heel pain issue but it will help temporarily to reduce the discomfort they are experiencing. This will also allow them to continue playing their sport This is why Top tip # 3 is so important. Check out our rehab guide now




TOP TIP 4 FOR PARENTS DEALING WITH THEIR CHILDS SEVER'S PAIN


TOP Tip #4: ADDRESS BIOMECHANICAL ISSUES Treating Sever’s heel pain is actually very easy. But there are NO MAGIC CURES!! Address any biomechanical issues that your child may have. These are issues that lead to overload of their bodies. The earlier you address these the better! These issues include:

  • Any abnormal foot pronation/supination

  • This is best assessed via a consultation with a qualified Podiatrist Click HERE to make an appointment today
  • Running technique, Click HERE to see free our Running course
  • Foot wear especially sports shoes and football boots (Click HERE to see our amazing guide on sports shoes and football boots for children).
Check out our rehab guide now




TOP TIP 5 FOR PARENTS DEALING WITH THEIR CHILDS SEVER'S PAIN


TOP Tip #5: MANAGE LOAD Finally but probably most importantly , You need to mange your child's activity levels (LOAD). Sever's Heel pain is an overload issue Children that are not active are less likely to have Sever's Heel pain. However we do want our children to be active and healthy. So you need to manage their load (or training sessions) It is important that we understand this final TOP Tip as without it your child will suffer Heel pain longer, even if we manage them well. Their are formulae to working our load in elite athletes called "OPTIMUM LOAD FORMULA" (Which we have downloadable PDF's for this), but with children its different. The research suggests any rapid increase in load can contribute to Sever's Heel pain. So as parents it is important to assess whether your child is doing too much. Sever’s heel pain can come and go very quickly but it can also be prolonged if left un treated. Ultimately once the heel growth plate tolerates the loads being placed on it or it has fused to the primary heel bone and growth has finished then the pain will not be there any more. Its our job to manage this process and allow it to happen smoothly with as least pain as possible. If you need more information or would like a consultation click here and we can organise one for you or your child right away. These consults can be done in clinic or online via our state of the art software that runs our business and rehab programs. Also, just so you know we offer a 4 week online program for your child. This program is amazing!!! The exact rehab you will learn about in the remainder of this course is delivered right to your smart device in video format each day. It will guide your child through the exact exercises you will learn about in this course and successful manage your chlids Sever's Heel Pain. Check out our rehab guide now





GOLD STANDARD TREATMENT FOR SEVER'S HEEL PAIN

Online rehabilitation for Sever's Disease Heel Pain in Children


The Lower Extremity Group offers to you the Gold Standard in Lower extremity injury rehabilitation. We utilise a World Class rehabilitation program for Sever's Disease, and this is deilvered to you online in the comfort of your own home. All you have to do is follow our easy to use evidence based plan to treat and manage your child's Sever's Heel Pain. This online program contains 4 complete weeks of revolutionary rehabilitation guides to help your child manage and treat their Sever's heel pain every single day. We deliver our evidence-based daily Sever's Disease management program via our amazing app, which is very easy for you to follow and includes 28 days of;

  • Progressive neuromuscular exercises that will strengthen the muscels around the foot and ankle and help reduce the pain associated with Sever's Disease Heel Pain
  • 5 progressive levels of evidence based rehabilitation that do not require expensive equpiment
  • Passive and dynamic mobility exercises to increase range of motion and tissue extensibility of mucles and fascia
  • ​Myofascial massage exercises
  • Using the app will enable you to understand when to apply the various exercises to help manage Sever's Heel Pain
  • Plus more
We offer online consultations as a part of the rehabiliation precess to help you rehabilitate and manage your Child's Sever's Heel Pain. ​Our experienced therapists have taken these aforementioned technical modalities and simplified them into easy to watch videos for you and your child to follow and complete. These are delivered daily to your smart device within our Sever's Disease management program. Book in today - Online or in clinic




In Clinic rehabilitation for Sever's Disease Heel Pain in Children


The Lower Extremity Group offers to you the Gold Standard in Lower extremity injury rehabilitation. We utilise a World Class rehabilitation program for Sever's Disease, and this is deilvered to you online in the comfort of your own home or in our state of art custom built lower limb rehab facility. All you have to do is follow our easy to use evidence based plan to treat and manage your child's Sever's Heel Pain. This revolutionary rehabilitation will help your child manage and treat their Sever's heel pain every single day. We deliver our evidence-based daily Sever's Disease management program via our amazing app, which is very easy for you to follow and includes 28 days of;

  • Progressive neuromuscular exercises that will strengthen the muscels around the foot and ankle and help reduce the pain associated with Sever's Disease Heel Pain
  • 5 progressive levels of evidence based rehabilitation that do not require expensive equpiment
  • Passive and dynamic mobility exercises to increase range of motion and tissue extensibility of mucles and fascia
  • ​Myofascial massage exercises
  • Using the app will enable you to understand when to apply the various exercises to help manage Sever's Heel Pain
  • Plus more
We offer online or in clinic consultations as a part of the rehabiliation precess to help you rehabilitate and manage your Child's Sever's Heel Pain. ​Our experienced therapists have taken these aforementioned technical modalities and simplified them into easy to watch videos for you and your child to follow and complete. These are delivered daily to your smart device within our Sever's Disease management program. Book in today - Online or in clinic





RECOMMENDED MEDICAL LITERATURE HUB

Sever's Disease (Calcaneal Apophysitis) - Denise R Ramponi et al


Abstract Sever's disease, or calcaneal apophysitis, is the primary cause of heel pain in pediatric patients between the ages of 8 and 15 years. Primary risk factors in pediatric athletes are obesity and high levels of physical activity. Sever's injury primarily results from high-impact sports such as soccer, track, cross-country, gymnastics, tennis, and ballet. This injury mainly occurs during puberty with an open growth plate in the immature calcaneus. Clinical diagnosis can be confirmed by performing a "squeeze test" of the heel on physical examination. Diagnostic imaging findings include increased sclerosis and fragmentation of the calcaneal apophysis on plain radiograph x-rays. Ice, activity restriction, stretching, nonsteroidal anti-inflammatory drugs, immobilization, and heel cups are all methods that can be utilized in treating the pain caused by Sever's. No long-term effects have been associated with Sever's disease. https://pubmed.ncbi.nlm.nih.gov/31599666/




Radiographic study of Sever's disease -  Yan Gao et al


Abstract of article X-ray and MRI differences of calcaneal epiphysis between Sever's disease patients and normal children were compared and analyzed to raise awareness of Sever's disease. A total of 98 children with Sever's disease were enrolled in the study, including 72 males and 26 females. Among them, 6 patients underwent MRI. There were 120 patients in the control group, including 73 males and 47 females, aged 8 to 15 years. The calcaneus epiphysis density (compact and cancellous bone type), the difference of the radiolucent line and the signal changes of Sever's disease on MRI of the two groups were observed and analyzed. Among the patients with Sever's disease, the male incidence rate was 79.59%, the female incidence rate was 20.41%, the average age of onset was 11.35, the average age of onset for male was 11.49, and the average age of onset for female was 10.80. There were significant statistical differences between the two groups in terms of epiphysis density (compact and cancellous type) and translucent line (χ2=38.85, 137.51, P<0.05). Six cases of MRI showed partial or complete different degrees of bone marrow, ligament, soft tissue edema, and joint effusion. Sever's disease is mainly characterized by increased density of the calcaneus epiphysis and a radiolucent line of the epiphysis. It manifests as heel edema on MRI image. https://pubmed.ncbi.nlm.nih.gov/32742336/




Sever's injury: a clinical diagnosis  - Stefan Perhamre et al


Abstract Background: The diagnosis of Sever's injury (apophysitis calcanei) has previously been partly based on radiographic findings in the calcaneal apophysis. Sclerosis and fragmentation have been supposed to represent signs of inflammation due to tractions from the Achilles tendon. The clinical findings, diagnostic criteria, and studied population are often poorly defined. We sought to define diagnostic criteria by analyzing clinical and radiographic characteristics in a population with Sever's injury and to compare the findings with those of a control group of matched, symptom-free children. Methods: We assessed 30 consecutive children with Sever's injury with high levels of pain but high physical activity levels in sports activities and 15 pain-free matched controls. Results: One-leg heel standing showed 100% sensitivity; the squeeze test, 97%; and the palpation test, 80%. All three tests showed 100% specificity. All of the patients and controls showed increased density of the apophysis. Half of the pain-free controls showed fragmentation versus almost 90% of children with heel pain. Conclusions: The diagnosis of Sever's injury is clinical, not radiologic. Radiologic findings of increased density and fragmentation are found also in pain-free controls with high levels of physical activity and may, therefore, represent normal growth and development. We suggest that the diagnosis of Sever's injury should be based on patient history and the results of two specific clinical tests. https://pubmed.ncbi.nlm.nih.gov/24072363/




"Effectiveness of interventions in reducing pain and maintaining physical activity in children and adolescents with calcaneal apophysitis (Sever's disease): a systematic review"


J Foot Ankle Res. 2013 May 3;6(1):16. doi: 10.1186/1757-1146-6-16. https://pubmed.ncbi.nlm.nih.gov/23641779/ Abstract Background: Calcaneal apophysitis, also commonly known as sever's disease, is a condition seen in children usually aged between 8-15 years. Conservative therapies, such as taping, heel lifts and orthotic intervention are accepted management practices for calcaneal apophysitis, though there is very little high quality research examining the efficacy of such treatment modalities. Previous narrative literature reviews and opinion pieces provide some evidence for the use of heel raises or orthoses. The aim of this manuscript was to complete a systemic review on the treatment options for calcaneal apophysitis as measured by pain reduction and maintenance of physical activity. Methods: A search strategy completed by two reviewers examined nine databases from inception to May 2012. Search terms included heel pain, children, adolescent, calcaneal apophysitis, sever's disease, treatment, and management (full text publications, human studies). Systematic reviews, randomised control trials, case series, and case studies were included. The reference lists of the selected articles were also examined. The methodology, quality and risk of bias was examined and assessed using the PEDro scale. Results: Nine articles were retrieved including three clinical trials involving randomisation, two case series, two retrospective case reviews, and two case reports. Effect size calculations and a meta analysis were unable to be completed due to the limited data reported within the literature. Numerous treatment options were reported throughout the literature, though few were examined against a control or alternate treatment option in well-designed trials. The limited evidence indicated that orthoses provided greater short-term pain relief than heel raises. Health practitioners should view these results with caution, as there were apparent methodological problems with the employed study design and limited follow-up of participants. Conclusion: There is limited evidence to support the use of heel raises and orthoses for children who have heel pain related to calcaneal apophysitis. Further research is needed to generate higher quality evidence with larger sample sizes, and validated measures of pain and function to establish effective treatment approaches for children with calcaneal apophysitis.