- Signs and Symptoms
The most obvious sign of Sever’s disease is pain or tenderness in one or both heels, usually at the back. The pain also might extend to the sides and bottom of the heel, ending near the arch of the foot.
A child also may have these related problems:
swelling and redness in the heel
discomfort or stiffness in the feet upon awaking
discomfort when the heel is squeezed on both sides
an unusual walk, such as walking with a limp or on tiptoes to avoid putting pressure on the heel
Symptoms are usually worse during or after activity and get better with rest.
A doctor can usually tell that a child has Sever’s disease based on the symptoms reported. To confirm the diagnosis, the doctor will probably examine the heels and ask about the child’s activity level and participation in sports. The doctor might also use the squeeze test, squeezing the back part of the heel from both sides at the same time to see if doing so causes pain. The doctor might also ask the child to stand on tiptoes to see if that position causes pain.
Although imaging tests such as X-rays generally are not that helpful in diagnosing Sever’s disease, some doctors order them to rule out other problems, such as fractures. Sever’s disease cannot be seen on an X-ray.
The immediate goal of treatment is pain relief. Because symptoms generally worsen with activity, the main treatment for Sever’s disease is rest, which helps to relieve pressure on the heel bone, decreasing swelling and reducing pain.
As directed by the doctor, a child should cut down on or avoid all activities that cause pain until all symptoms are gone, especially running barefoot or on hard surfaces because hard impact on the feet can worsen pain and inflammation. The child might be able to do things that do not put pressure on the heel, such as swimming and biking, but check with a doctor first.
The doctor might also recommend that a child with Sever’s disease:
perform foot and leg exercises to stretch and strengthen the leg muscles and tendons
elevate and apply ice (wrapped in a towel, not applied directly to the skin) to the injured heel for 20 minutes two or three times per day, even on days when the pain is not that bad, to help reduce swelling
use an elastic wrap or compression stocking that is designed to help decrease pain and swelling
take an over-the-counter medicine to reduce pain and swelling, such as acetaminophen (Tylenol) or ibuprofen (Advil, Motrin, Nuprin)
In very severe cases, the doctor might recommend that the child wear a cast for anywhere from 2 to 12 weeks to immobilize the foot so that it can heal
- Recovery and Recurrence
One of the most important things to know about Sever’s disease is that, with proper care, the condition usually goes away within 2 weeks to 2 months and does not cause any problems later in life. The sooner Sever’s disease is addressed, the quicker recovery is. Most kids can return to physical activity without any trouble once the pain and other symptoms go away.
Although Sever’s disease generally heals quickly, it can recur if long-term measures are not taken to protect the heel during a child’s growing years. One of the most important is to make sure that kids wear proper shoes. Good quality, well-fitting shoes with shock-absorbent (padded) soles help to reduce pressure on the heel. The doctor may also recommend shoes with open backs, such as sandals or clogs, that do not rub on the back of the heel. Shoes that are heavy or have high heels should be avoided. Other preventive measures include continued stretching exercises and icing of the affected heel after activity.
If the child has a pronated foot, a flat or high arch, or another condition that increases the risk of Sever’s disease, the doctor might recommend special shoe inserts, called orthotic devices, such as:
heel pads that cushion the heel as it strikes the ground
heel lifts that reduce strain on the Achilles tendon by raising the heel
arch supports that hold the heel in an ideal position
If a child is overweight or obese, the doctor will probably also recommend weight loss to decrease pressure on the heel.
The risk of recurrence goes away on its own when foot growth is complete and the growth plate has fused to the rest of the heel bone, usually around age 15.
- TREATMENT AND STRECHES
Place your hands on a wall in front of you while placing one foot in front of the other. Keeping both your heel flat on the ground, bend your knees so that you can feel the lower part of the leg stretch. Hold this position for about 15 seconds and repeat this stretch several times.
This exercise is useful in stretching the lower leg, particularly the muscles in the calf and the Achilles tendon. By doing this, it can release tension not only in the lower leg, but also tension and stress placed on the plantar fascia.
Heel Pain Exercise – BELT STRETCH:
Take a wide belt and hold one end in each hand. Place the center of the belt over the ball of the foot. With your knee straight, pull your ankle back toward you using the belt and the muscle on the front of your leg. Think about reverse stretching your arch. Pull back and hold for ten seconds. Relax and repeat for five to ten minutes.