What is Sever’s Disease?

Sever’s isn’t really a ‘disease’ as such. Sever’s is an inflammation of the growth plate at the back of the heel, which occurs in growing, adolescent children.

What causes Sever’s?

As children go through their ‘growth spurts’, bones will grow faster than muscles and tendons. Because of this, in Sever’s, the tendon at the back of the heel (Achilles tendon) pulls at the heel bone. Thus, due to repetitive stress, it is particularly common in active children.

How is Sever’s diagnosed?

Sever’s is pretty easy to diagnose through a thorough assessment. The history, your symptoms and the pattern of the problem will paint a picture that leads to the diagnosis. A thorough assessment involves matching the symptoms reported to a physical examination of the heels, alongside discussing activity level and participation in sports.

What might Sever’s feel like?

Sever’s presents as pain in the back of the heel, often present in day to day activities such as walking, and made worse during or after physical activity – especially sports involving running and jumping.

How do the symptoms of Sever’s progress?

The pain caused by Sever’s tends to be directly linked to activity levels. What’s most frustrating about this is that it’s often the most active kids that suffer with it, so limiting their activity can be quite distressing.

The condition may get worse and may be more difficult to treat if you ignore the symptoms and carry on high levels of activity through it. Therefore, without the correct management, the symptoms of Severs can persist until growth stops. Whilst there is no direct treatment that can stop the pathology of Severs, there are many things physiotherapy can do to help relieve and manage the symptoms.

What is the best treatment for Sever’s?

One we have a diagnosis of Severs, we will really focus on helping your child manage the condition.

This can include:

• Advice on pain relief and managing the symptoms
• Guidance on sport and activity modification, a term we call ‘relative rest’
• Exercises to stretch and strengthen muscles in the lower limb, foam rolling can be great
• Shoe modifications, 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, or arch supports that hold the heel in an ideal position

The outlook for Sever’s 

The sooner Sever’s is managed, the quicker recovery can be, and with correct management, the condition usually goes away within a few months. The problem does not cause problems later in life.

Related injuries

Severs in very similar in nature to Osgood Schlatter’s of the knee. However, other conditions we consider when children present with heel pain include:

• Plantar fasciitis
• Achilles tendon issues
• Heel spur
• Fat pad irritation

Severs Case Study 

11 year old Joe came to see us complaining of a 3 month history or worsening heel pain. Joe was an extremely enthusiastic grass roots football player, training and playing 4 times a week. He’d recently started trampolining, which he loved! However, his heel pain was starting to get so severe, it was limiting his ability to play football, with him often limping off the pitch after 30 minutes.

When he came to see us, we found he had:

• A significant tender spot on both heels
• Naturally flattened arches in his feet
• Very tight, painful and tense calf muscles

Joe’s Management 

The first steps we took, were to educate and reassure Joe about his condition. Sometimes this reassurance and understanding can be a turning point in recovery – it isn’t anything serious and it will get better!

We taught Joe’s parents a treatment protocol, called The Strickland Protocol. This is a set and timed programme of rest, muscle release and re-introducing activity and stretching.

Joe was advised a short period of complete rest from any impact activity (with the reassurance of the long term gains of this) with a gradual re-introduction. In Joe’s case, he was advised to stop trampolining and football completely for a few weeks, to try and help settle his symptoms as they were so severe. He started a daily treatment programme at home that his parents could help with – the aim of this was to reduce tension of calf muscles and start to reduce the pull on his heel bone. He also used ice on his heels and painkillers when necessary to ease the pain.

As his symptoms eased, stretching and foam rolling of his calf muscles was started and activity was carefully re-introduced.

It was concluded that trampolining was likely to have been one of the main triggers of his problem. Given that returning to football was his upmost priority, it was decided in conjunction with his parents that returning to trampolining was not advisable. Instead, Joe started swimming regularly. The benefits of this were that swimming would help maintain and improve his fitness, whilst being low impact and not irritating his heel pain. He gradually increased his football playing time, using pain levels as a guide and building on time gradually.

We also guided him on his choice of footwear – to wear supportive and cushioned trainers and school shoes and a really good, supportive football boot. Many of the football shoes that are now on the market look great but offer absolutely no cushioning or support. Particularly astro boots, which are like running around on a piece of cardboard! Joe opted for a traditional leather boot, which offered much more support. He was advised to minimise playing in astro boots as much as possible.

It has taken almost a year of guided management for Joe to return fully to normal activity free from pain. What has reassured Joe and his parents is that they understand what’s going on, have made the right informed choices to help recovery and enabled Joe to get back to doing what he loves, playing football! Much of this management was advice and education and Joe doing a regular programme of exercises himself at home.

Had he not had the right advice, Joe could have gone down a route of spiralling inactivity and developed secondary issues – not only physical but also psychological, if he couldn’t play football.

If you’d like some advice on managing Sever’s or any other growing pains, give us a call on 023 8025 3317. 

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