Last Updated on March 14, 2023 by Dr. Saqib Mueed
Saver’s disease also called calcaneal apophysate is one of the most well-known reasons for heel torment in developing youngsters and youths. It is an irritation of the development plate in the calcaneus heel.
In the case of sever’s, disease inflammation Severe pain occurs due to injury in the lower back of the heel. Such kind of disease is most common among children and mostly occurs in those children which take part in exercise and playing games regularly. In such a condition disease pain occurs in the back of the heel and usually, it also moves towards both sides and also on the bottom side of the heel.
The scientific name of sever’s disease is Calcaneal Apophysitis
Sever’s disease mostly occurs during the teenage lifespan. In the case of girls, such kind of disease occur during the age of 8 to 13 years and in the case of boys, it usually occurs between the age of 10 to 15 year.
Severs disease almost occurs in children not in elders because the heel of the elder ones become stronger and harder so that’s why when a child gets elder the problem of sever’s disease does not occur.
It is not so common that sever’s disease occurs again and again. For example, is a child take part in playing activities regularly and once caught by sever’s disease but in next time wearing good sports shoes provide the support to the foot and heel and the sever’s disease doesn’t reoccur.
In 1912 an American doctor first describe the conditions of that disease. His name was James Warren Sever. After 1912 this disease is commonly known as the sever’s disease.
According to James Warren Sever. The symptoms are the common cause of heel pain and inflammation.
Causes of Saver’s disease
The reason for the severe disease is that the bone of the heel grows faster than the ligaments in the heel.
Due to this condition, the muscles and tendons of the heel become over starched and harder in those children which are in high growth age. Sever’s disease occurs due to the frequent stress on the ligament.
With time overstress on the muscle’s ligament can damage the growth plate which may become the reason for injury, inflammation, and severe pain in the heel.
There is a specific Position in the bone of the child where the bone is growing This special position is also known as the Growth plate. A growth plate is usually present at the end of the bones where cartilage is present.
This growth plate provides a position of attachment of the tendon. A tendon is a bundle of strong tissues that connects the muscles of the led with the heel.
During the growing age, the growth plate is softer, and when the child is fully matured the growth plate is closed and is replaced by hard bone.
Sometimes due to the additional stress on the tendon may increase the inflammation and pain in the heel.
When the child is fully matured, and the growth plate is replaced by bone then the sever’s disease will never come again in the whole life.
Symptoms of Saver’s disease
There are different symptoms of Sever’s Disease Some of the is Given in the following
The pain will appear in the backside of the heel and also will move toward the left and right side as well as the bottom side of the heel. The child will also feel difficulty in running, jumping, and taking part in other activities like sports
The symptoms of laziness and tiredness will also appear in the child, and he didn’t want to take part in any kind of activity which increase the stress and pain of the heel Inflammation and redness will also appear on the foot.
The symptoms of the savers’ disease will become more adverse during any kind of physical activity and also after performing any hard activity. The condition becomes more comfortable in the resting condition.
The child feels no pain in the heel when he gets up after sleep in the morning. The pain will increase in the heel when it bears the weight of the body. While wearing shoes that have a hard surface may increase the irritation in the heel.
Sometimes redness will also appear on the heel due to the severs disease. The patient will also feel the stiffness of the foot during the walking.
The child suffering from the sever’s disease will also try to put all of their body weight in their toes and it is observed that patients will always try to avoid putting their weight on the heel due to the feeling of pain in the heel.
In case of severs disease, the patient may also feel little pain in the leg region if the disease gets more severe conditions.
In the severe conditions of the sever’s disease, the patient tried to keep rest and keep the foot immobile as it is possible for the patient.
Because in severe conditions the pain will increase extraordinary, and the affected part of the heel may also be swelled.
Diagnosis of Saver’s disease
- There are different methods to diagnose sever’s disease. A physician will apply the diagnostic method according to the symptoms which will appear in the child.
- The physician may also practice different small exercises of the foot and leg and will come to know that how much the symptoms of the disease will become more severe.
- For a complete treatment of the sever’s disease, the doctor will completely diagnose the patient’s disease by asking about any medical history and also about the recent physical activities.
- Then the doctor will also perform a physical test of the heel to know about how much the condition is severe. The doctor will perform a squeeze test.
- It is a test that is performed by contracting the growth plate and the surrounding muscles of the heel to provoke the pain.
- This test is very important to diagnose severs disease. The doctor will also take an x-ray result of the heel to diagnose the disease properly
- It is a technique in which x-rays are used to saw the broken or fracture part of the heel. By getting the x-ray diagram the diagnosis will become easier and the doctor will easily suggest the way of treatment.
Treatments of Saver’s disease
- The main focus during the treatment of the sever’s disease is to reduce the pain and swelling from the heel. It may also be done by giving the pain killer and anti-inflammatory medicine to the patient.
- If the disease is a severe condition, then a complete rest from all kinds of physical activity is required. The rest time required for complete healing may up to several months.
- And if a child didn’t have any severe condition of sever’s disease then taking part in small physical activities like sports may be safe. For treatment, the doctor may also apply some other additional methods to cure the disease:
- The doctor may suggest using heel pads and cushion pads in sport’s shoes which reduce the impact of stress on the heel and ankle while playing.
- It is also recommended by the doctor to use such kind of sports shoes which have high elevated heels because the elevated heel of the shoes may also help in reducing the stress on the growth plate and protect from sever’s disease.
- The doctor will also recommend taking part in stretching exercise which keeps the growth plate healthy and active and reduce the chances of disease to reappear
- Medicines like ibuprofen are used to reduce the inflammation and swelling
- Some pain killer gels are also recommended by the doctor to apply on the heel which helps to reduce the pain and swelling
- To reduce the swelling, the doctor will also recommend using the ice packs to put on the heel. The ice packs should not be put directly on the heel because the direct contact of the ice can cause the ice to burn on the skin.
- The ice packs should have wrapped in the towel and be kept on the heel for 15 minutes up to 2 times a day.
- The exercise of the leg and heel are also helpful in curing the sever’s disease, but all of these exercises should also have done under the observance of the physiotherapist so that no more complications increase for the patient.
- For example, the physiotherapist will straighten the leg of the patient and gently bend the foot toward the belly side of the body for up to 30 seconds.
- The physiotherapist will repeat the process for other feet. This exercise is taken by a physiotherapist for up to 20 minutes in a day. It is the best method for curing of this disease.
- For the complete treatment of the sever’s disease, the physiotherapist will also perform physical exercises such as stretching of the tendon and muscles of the heel.
- The doctor will also use orthotic devices to provide support to the heel.
Recovery from disease:
- In the sever’s disease, the patient will not have to suffer from very long complications. Most children can restart their complete physical activity after the pain has gone from the heel.
- During the treatment of the sever’s disease, 3 to 8 weeks are also taken for the complete cure of the disease. The reoccurrence of the severs disease might also be possible if the good steps are not followed to reduce the causes of the sever’s disease.
Prevention from sever’s disease:
Following tips are recommended to get prevention from the sever’s disease.
- The major and first step to avoid disease is to get rid of obesity
Because due to obesity several diseases may occur and sever’s disease is from one of them.
- The shoes selected for the child for playing must be well constructed and well designed in such a way that shoes absorb the impact of stress from the growth plate.
- Sever’s disease can also be prevented by avoiding such kinds of activities that are beyond the child’s ability.
- Small activities like stretching exercises may also help in the prevention of sever’s disease.
- To prevent the severs disease it is recommended that not to wear the high heel shoes because it can apply more stress on the growth plate which leads to more damage to the heel.
- It is recommended that after any kind of physical activity to put the ice on the heel wrapped in a cloth. It is because that it will release the stress from the tendon of the heel.
- If the sever’s disease conditions get more severe then little walking also becomes difficult and complete immobilization is required to cure the disease properly.
- During this period the doctor will also recommend keeping some gentle exercises of the leg and foot so that’s why the disease is cured as early as possible.
- It is also recommended by doctors to wear the heel cups with shoes because it will provide extra protection to the heel and keep the heel safe from any fatal stress or any injury.SEVERS DISEASE VPON – PDF.pdf (rch.org.au)seversdisease.1.0.pdf (aap.org)OIC_Collateral_singlesheet_SeversDisease_r1.pdf (ortho-institute.org)
Dr. Iqra Chaudhary
Medical Officer, Red crescent hospital, Sargodha
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