Sever's Disease - Achilles Heel Pain (Children 8-15 years old)

Sever's disease affects growing adolescents in the 8-15 age category. A child suffering with Sever's will complain of pain around the back / base of the heel bone (called the calcaneus).

The basics 

Put simply the Achilles tendon, at it's attachment to the heel, becomes inflamed. This can occur for a few reasons however normally the primary issue is that the growth plates in children at this age are yet to full develop and are therefore more susceptible to 'overuse' type injuries. In a growing child weight bearing activity will generally aggravate the injury. This occurs because there is too much force being placed on the tendon attachment during weight bearing activity.

Risk factors

Sever's disease is a very similar issue, in nature, to Osgood Schlatters (OSD) and is effected by many of the same risk factors, e.g. increased activity, leg length discrepancies, recent growth spurts, poor bio-mechanics in sporting activities, tight calf musculature or being over weight / obese.

|| Osgood Schlatters occurs at the knee ||

|| Severs Disease occurs at the Achilles heel ||

Treatment / Management

The good news is that most children will 'grow out' of this injury within 2 week - 6 months. It is important it's managed carefully in the mean time though. If managed incorrectly there is the possibility of a calcification (permanent bony deposit) developing at the base of heel.

Generally decreased activity will be required. This is usually on a the basis of pain free activity, meaning that pain free activity is fine, painful activity is not. 

As with OSD the same treatment options are applicable for Sever's Disease: 

Treatment for Sever's will involve:

1. Rest (or relative rest) - by 'relative rest' I mean that ALL activity must be pain free. If an activity causes pain then rest must be enforced. 
2. Soft tissue techniques (massage) to free up the tight muscular tissue. 
3. Bio-mechanical screening - to make sure no unnecessary force is being generated at the foot, ankle or heel. 
4. Light stretching - only when appropriate. 
5. Ice / cold treatment - to help manage the inflammation. 

Two things you must not allow your child to do if they have Sever's disease:

1. Train / play through pain. 
2. Stretch heavily if it causes pain.

Plantar Fasciitis (Heel Pain)

The Plantar Fascia is a thick band of fibrous tissue which helps provide support to the arch of your foot. If it becomes injured it can cause pain, most commonly found around the under side of your heel.

Plantar fasciitis is generally caused by 'overuse' of the fascia, 'itis' means inflammation, so a diagnosis of Plantar Fasciitis simply indicates that the fascia has become inflamed.

When the condition is at it's worst, it can be painful to walk even small distances.

The underlying cause of the condition will often come down to poor biomechanics of the lower limb and/or tight or shortened muscles (often the calves).

Treatment for Plantar Fasciitis has to be specific to the individual, however treatments may include:

• Specific stretches for shortened muscle groups
• Home exercises to correct poor biomechanics
• Massage to reduce the tension in the Fascia (and tight muscles)
• Mobilisations at home to 'stretch' the Fascia

As always for the purpose of these blog posts, I'm keeping the information fairly basic. There are other issues that can occur around the foot. If you do have any additional questions please do email me at alex(at)theringwoodclinic.co.uk

Here is an additional resource with some more information on plantar fasciitis.