Sever's Disease | Plenty Physiotherapy, Bundoora

Sever's Diease Document

Sever’s disease is an overuse traction injury at  the calcaneal growth plate (apophysis), where  the Achilles tendon attaches. This condition is  common in active children aged 8–14 during  growth spurts, before the calcaneal growth   fused. It is one of the most commcauses of heel pain in growing athletes.  Common in sports involving running, jumping,  or rapid changes of direction (e.g., football,  basketball, and netball).  Due to this type of increased physical activity, this  region undergoes repetitive pulling of the Achilles  on the unfused calcaneal apophysis causing microtrauma and inflammation in this region of  insertion. It is mainly self-limiting; it resolves once growth  plate closes (usually by the ag15). Symptoms  often settle within 2–3 months with appropriate  anagement but can recur during high-load  phases until skeletal maturity. There is a  favourable prognosis for great long-term outcomes  with no lasting damage if managed well. Contributing Factors: A) Rapid growth spurts: A large factor is that adolescents in this age group will  have periods of growth spurts which are correlated to either the development or  flaring up of Sever’s disease. This is the case as the growth of bone is much  faster than the lengthening and growth of the muscles. Due to the muscles  originating and inserting into the bone (the site here being the calcaneus), this  difference in growth rate leads to the pulling, anchor-like tension on the insertion  site.  B) High training loads/activity: High training loads and adolescents who  participate in more volumes and intensity of physical activity (such as soccer,  football, running, jumping, and sports in general) will cause more strain and  activation of the triceps surae and Achilles tendon, therefore irritating the  tension created by increased muscle contractions at the growth plate insertion  sites as discussed above.  C) Inadequate recovery: Poor recovery periods between activity, matches or  training sessions will be responsible for higher periods of tension and symptom irritation without respite to calm down symptoms. This may lead to longer  periods of discomfort as well as increased irritability likelihood.  D) Muscle imbalances: It has been found that having reduced strength or poor  flexibility in the calf muscle and foot intrinsic muscles can be a factor in this  condition due to a lack of optimal foot and ankle biomechanics as well as  incorrect load distributions.  E) Poor footwear/ mechanics: a. Overpronation (Flat feet) b. Reduced Ankle Dorsiflexion (Tight/reduced strength of calf muscles) c. Rigid High Arches (Poor shock absorption and increased fascia tension)  

All of these can contribute to the development/flaring up of Sever’s disease due to the  increase in stress accumulation of this region. Therefore footwear that does not  support the foot appropriately to counter these biomechanical deficits will contribute  negatively.  Treatment/Management: 1) Ice, medication and compression: Ice as well as using forms of pain relief/anti inflammatories (as directed by your medical professionals) can help manage  acute bouts of pain. Compression can help if there is any swelling present.  2) Education/Rest and load management: Initially minimise or remove aggravating factors and activities. These factors can be things such as  minimising running, hopping and jumping. Load management is crucial,  therefore laying out your current exercise/sports schedule and modifying things  such as frequency, duration and intensity will aid this. It may be that in addition  to strength work, low-impact cardiovascular (CV) activities such as cycling and  swimming may be advised so that secondary regressions of CV fitness are not a  resultant. Educating about these topics is crucial.  3) Strength and stretching rehab exercises: Exercises not only to increase  flexibility of the calf and ankle muscles but also aiming to increase the strength in these muscles can help with optimising ankle/foot mechanics, reducing the  risk of overloading and irritating this condition.  4) Orthotics/footwear: Appropriate footwear or orthotics may support your arch  and foot mechanics to help the lower limb’s overall biomechanics, but it may  also help soften the forces through the calf and Achilles tendon region by  absorbing more force evenly. 5) Taping/other modalities: Specific taping techniques may be implemented by  your physiotherapist to load and encourage optimal foot mechanics. Other  modalities may also be utilised such as massage and mobilisation of the ankle  joint. 6) Exercise-rehab: Exercises targeting muscle imbalances and poor  biomechanical patterns, including the lower limb and foot, will aid in proper  movements and optimal loading. 7) Imaging/Referral: In some more severe cases certain imaging referrals (such as  X-rays and ultrasound) may help rule out more sinister issues like avulsion  fractures. A sports physician may also be referred to in these cases.