How You Can Diagnose Severs Disease?

Overview

Sever?s disease, also known as calcaneal apophysitis or Osgood-Schlatter syndrome of the foot. This traction apophysitis is secondary to repetitive microtraumata or overuse of the heel in young athletes. The calcaneus is situated at the most plantar posterior aspect of the foot. The Achilles tendon inserts to the lower, posterior and slightly medial aspect of the calcaneus. The plantar fascia originates from the medial tubercle on the plantar aspect of the calcaneus. Proximal to the epiphysis is the apophysis, where the Achilles tendon actually inserts. The calcaneal growth plate and apophysis are situated in an area subject to high stress from the plantar and Achilles tendon.

Causes

This condition is more common in boys than girls. It generally presents between the ages of 9-14 and peaks between ages 10-12 years. This injury can reoccur up until the age of 17, when the growth plate of the calcaneous generally closes. These types of injuries will commonly occur during periods of rapid growth. Sever?s Disease occurs more frequently in child with flat feet, but all children with flat feet will not get Sever?s.

Symptoms

Signs and symptoms of Sever?s disease include heel pain can be in one or both heels, and it can come and go over time. Many children walk or run with a limp, they may walk on their toes to avoid pressure on their heels. Heel pain may increase with running or jumping, wearing stiff, hard shoes (ex. soccer cleats, flip-flops) or walking barefoot. The pain may begin after increasing physical activity, such as trying a new sport or starting a new sports season.

Diagnosis

The doctor may order an x-ray because x-rays can confirm how mature the growth center is and if there are other sources of heel pain, such as a stress fracture or bone cyst. However, x-rays are not necessary to diagnose Sever?s disease, and it is not possible to make the diagnosis based on the x-ray alone.

Non Surgical Treatment

Sever?s disease will go away on its own with rest or after heel bone growth is complete, usually within 2 to 8 weeks after the heel pain or discomfort appears. Sever?s disease is not expected to cause long-term problems, though symptoms may linger for up to several years in severe cases. Certain conservative care measures may be helpful in treating this health problem, including avoiding activities that provoke pain or discomfort, elevating the leg while at rest, performing hamstring and calf muscle stretches two to three times per day, undergoing physical therapy, using cold therapy, using an elastic wrap or compression stocking, Avoiding footwear with heel elevation, toe spring, and toe taper, and instead favoring footwear that?s completely flat and widest at the ends of the toes. More aggressive treatment measures, including over-the-counter anti-inflammatory medication (e.g. ibuprofen), steroid injections, and surgery, may be indicated in certain cases. Addressing the footwear component of this health problem is an important part of a well-rounded Sever?s disease treatment plan. Optimal footwear for preventing or treating this problem is flat, wide (widest at the ends of the toes), and flexible in the sole. Open-back footwear (such as certain Crocs models) may be particularly helpful for kids and teens with Sever?s disease.

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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