Activity induced heel pain is children is usually a self-limiting condition and often resolves in time. However, during that time, the owner of that pain does not have to suffer. Avoiding physical activities with piers stunts growth at many levels often finding the child sitting on the couch in front of the TV or electronic video screen. Avoiding sports at any level, taking medication or suffer the agony of d’feet is no longer necessary. While heel pain from Sever’s disease may years to resolve on its own, there is immediate relief awaiting the child with this debilitating condition.
While many have postulated a variety of causes of Sever’s Disease, from hormone deficiencies to who knows what, the primary cause of pain in the back of the heel in growing children, is in fact a torqueing of the growth plate between the ages of 7 and 14. With boys more effected than girls, the common finding is excessive side to side movement of the heel on contact and thru forefoot loading prior to the propulsive phase of walking or running at a time when the Achilles’ tendon is pulling on the heel from above. The force of the side to side movement at heel strike coupled with the pull from the tendon above loosens the interface between the growth plate (apophysis) and the actual body of the heel known as the calcaneus. It is labeled self-limiting because the growth plate eventually closes, and the two segments become one solid bone. A classic sign of excessive motion is the top of the heel tilting toward the mid-line of the body in stance as viewed from behind.
Treatment for this condition is straight forward. Every attempt is made to maintain the heel in a vertical position with a few degrees of motion to allow for adaptation of the heel to the ground and help the body avoid the impact shock to the leg and low back. A competent lower extremity exam usually will reveal the primary cause of the excessive heel motion and once established, either a pre-fabricated orthotic or a custom made functional orthotic placed in the shoe prevents the excessive side to side motion and the inflammation and pain stops in a few days without the need for analgesics or anti-inflammatory medication. Rest and ice are almost always unnecessary with most children returning to all activities of choice without re-occurrence of the pain.Aveon Health Steven E. Tager, DPM, FAAPSM Scottsdale, AZ 85255 (480) 300-4663