Ethyl Sabine

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Overview


Sever's disease is a common cause of heel pain in adolescence. Developing, physically active ?kids? are more prone to Sever's. During puberty the calcaneus consist of two developing sites of bone known as ossification centres. These two areas are seperated by an area of cartilage known as the calcaneal apophysis. The Achilles tendon attaches the triceps surae (calf muscles) to the calcaneus (heel bone). As a child grows the calcaneus grows faster than the surrounding soft tissue, which means the Achilles tendon is pulled uncomfortably tight. This increase in strain causes inflammation and irritation of the calcaneal apophysis (growth plate) which is known as Sever's Disease. The pain is exacerbated by physical activities, especially ones involving running or jumping. Sever's disease most commonly affects boys aged 12 to 14 years and girls aged 10 to 12 years, which corresponds with the early growth spurts of puberty.


Causes


Predisposing Hereditary Factors: These are a biomechanical defect that one may be born with, which increases the chances of developing Sever's Disease. Short Achilles Tendon, When the Achilles Tendon is short from birth, it will exaggerate the tightness of this tendon that occurs during a child's growing years. This makes the pull of the Achilles Tendon on the heel's growth plate more forceful than normal, causing inflammation and pain, and eventually Sever's Disease. Short Leg Syndrome, When one leg is shorter than the other, the foot on the short leg must plantar flex (the foot and toes bend down) in order to reach the ground. In this way, the body tries to equalize the length of the legs. In order for the foot to plantar flex, the Achilles Tendon must pull on the heel with greater force than if the leg was a normal length. Thus the heel on the short leg will be more susceptible to Sever's Disease during the foot's growing years. Pronation. Is a biomechanical defect of the foot that involves a rolling outward of the foot at the ankle, so that when walking, the inner side of the heel and foot bears more of the body's weight than is normal (click here for more information about pronation). Pronation thus causes the heel to be tilted or twisted. In order for the Achilles Tendon to attach to the heel, it must twist to reach its normal attachment site. This will shorten or tighten the Achilles Tendon and increase the force of its pull on the heel's growth plate. This will increase the tightness of the Achilles Tendon during the foot's growing years, and may help to initiate bouts of Sever's Disease. Flat Arches and High Arches. Both of these biomechanical foot defects effect the pitch, or angle of the heel within the foot. When the heel is not positioned normally within the foot due to the height of the arch, the Achilles Tendon's attachment to the heel is affected. This may produce a shortening or tightening of the Achilles Tendon, which increases the force of its pull on the heel's growth plate. During the foot's growing years, abnormal arch height may contribute to the onset of Sever's Disease.


Symptoms


If your child is suffering from this disease they will be experiencing pain and tenderness in the back of their foot. This soreness can also extend to the sides of the feet. Other sure signs of this disorder include swelling and sensitivity to touch. Because of the amount of discomfort, your child may find it difficult to walk or run. Pay attention to the way your child is walking. If you notice unusual posture or abnormal gait they may be avoiding placing pressure on the heel. These symptoms typically become apparent during activity and exercise or directly following it. If your child is indicating pain in their heel, schedule an appointment with us today.


Diagnosis


A physical exam of the heel will show tenderness over the back of the heel but not in the Achilles tendon or plantar fascia. There may be tightness in the calf muscle, which contributes to tension on the heel. The tendons in the heel get stretched more in patients with flat feet. There is greater impact force on the heels of athletes with a high-arched, rigid foot.


Non Surgical Treatment


Primary treatment involves the use of heel cups or orthotics with a sturdy, supportive plastic shell. Treatment may also include cutting back on sports activities if pain interferes with performance, calf muscle stretching exercises, icing, and occasionally anti-inflammatory medications. Severe cases may require the short term use of a walking boot or cast.


Exercise


For children with Sever's disease, it is important to habitually perform exercises to stretch the hamstrings, calf muscles, and the tendons on the back of the leg. Stretching should be performed 2-3 times a day. Each stretch should be performed for 20 seconds, and both legs should be stretched, even if the pain is only in one heel. Heel cups or an inner shoe heel lifts are often recommended for patient suffering from Sever's disease. Wearing running shoes with built in heel cups can also decrease the symptoms because they can help soften the impact on the heel when walking, running, or standing.
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