Your child is complaining they have heel pain. They have grown more in the past month than they have ever and its scary to think how much they are changing, and fast! Some of the time their heel pain is non existent. You won’t hear them complaining about it for a few weeks and all of a sudden.. they are limping around in pain after school or a sports activity/match and you’re thinking to yourself what on earth has happened!? As they’re putting on their school shoes and filling up their school bags to the point where it is bigger than them.. seeing them limp out the door with their backpack looking like a tortoise shell or a military soldier on a pack march makes you scream guilty inside then you’re not alone. There is an answer to why your child’s heel pain is occurring and the reason for your child’s heel pain is most like Severs’ Disease.
Now before you read on, Severs’ Disease is not an actual disease. It is a condition that affects where the Achilles tendon inserts into the heel bone. This condition is very common in adolescents males and females between the age of 7 – 15, especially at the time of a growth spurt and when there is an increase in the volume of weight-bearing activities such as pre season training and mid season between multiple sports at once. As the young athlete’s bones grow at an accelerated rate through the growth spurt, the growth of the bone occurs at the growth plate. Specifically to the heel bone, the Achilles tendon attaches onto the growth plate.
As the calf muscles fail to lengthen at the same rate as the bone, the muscle and tendon are put on stretch. This adds tension to the attachment of the Achilles tendon which has a pulling (stretching) effect on the underlying growth plate at the calcaneus (heel bone). Through strong contractions at the calf muscle in actions such as sprinting and jumping, the amount of force which is put through the growth plate can also compress the region, further irritating it, thus causing more pain.
Activity related pain can be present from the back of the heel to underneath the sole of the foot. Severs is a self limiting condition and can lead to considerable time off sport or activity if managed inappropriately. The calf muscles will usually be tight. In highly active children this can cause a significant amount of pain, especially in sports involving running, jumping and explosive leg movements. Pain generally comes in bouts which relate to the amount of training or high intensity weight bearing activity they are doing. With more activity and sport over what their body can handle, the more at risk you are of increasing pain and thus reducing your ability to participate in sport, temporarily.
Once identified, treatment is focused on managing the injury conservatively. No scans are needed to help diagnose Severs. Pain on activity can last anywhere from as little as 2 weeks, all the way up to 6 to 12 months. The reason for why the timeframe is so variable is because your child will continuously undergo growth spurts through their adolescent years. Depending on if your child is going through a growth spurt, plus their current training load/amount of activity will determine the amount of pain they will be in. Managing Severs is focused on activity modification and growth rate monitoring. Although complete rest will not speed up the healing process, a reduction in explosive and weight-bearing activity will result in reduction of pain. Stretching of the affected calf muscles in the early phases will likely aggravate the injury.
A biomechanical assessment is essential and may reveal an asymmetry or dysfunction which when corrected can dramatically reduce the stress on the heel/tendon. A heel lift/heel cup and supportive footwear (good shoes/trainers/boots) are usually prescribed to reduce tension on the Achilles. Initial management should largely be prescribed around symptom management and activity modification. A gradual return to play/sport program should be followed to minimize risk of recurrence along with an injury maintenance program which focuses on improving known strength deficits outlined in testing, as well as optimizing movement patterns specific and desirable to improved athletic development.
Calculating Peak Height Velocity (PHV) monthly gives us an accurate score of your child’s growth rate. PHV is the period in which an adolescent experiences their fastest upward growth. It is during their PHV which they are more likely to sustain an acute, or overuse injury. To calculate PHV we take the date of the test, date of birth of the child, weight, standing height and seated height. The total equation gives us a score in which we will reflect if your child is in their pre growth phase, within their growth phase or post their growth phase. If they are in their growth phase / PHV than it is likely a modification in training load is necessary, as well as intervention to improve physical development in the child.
Once returned to sport, coach and parent education is critical in managing pain levels for players with Severs. This includes the continued adherence to prescribed exercise programs, proactive icing, creams, gels, foam rolling, regularly checking PHV and adequate sleep, nutrition and rest can significantly reduce ongoing pain and turn Severs into a manageable condition. Furthermore, shaving 10%-20% of total weekly training volumes, or intensity are other fantastic ways to ensure Severs pain does not increase above a high threshold. More than a 5/10 pain on the Modified VAS scale is starting to be too high, therefore reduction in ‘load,’ in the form of weekly training and games is highly recommended.
Again, when dealing with self limiting conditions like Severs, proactive pain management, a gradual build up, and ongoing progressive exercise adherence is critical in keeping your child playing their desired sport or activity to their very best. If your child, or another child in your sporting organisation is suffering from Severs pain, book now to have the condition addressed appropriately so you have the tools necessary to manage Severs, and to see your child return to sport to the best of their ability .
