Recognizing Sever’s Disease in Active Children

Inspired by a recent patient, we’re raising awareness about Sever’s disease, a common but often underdiagnosed cause of heel pain in active children. This condition affects the growth plate of the heel, leading to pain and discomfort, especially in young athletes. While occasional aches from physical activity are normal, Sever’s disease should not be overlooked, as it can significantly impact a child’s ability to stay active. In this blog, we’ll explain the causes and symptoms of Sever’s disease, how physical therapy plays a key role in treatment, and offer tips on preventing this painful condition before it starts.

What is Sever’s Disease? 

Sever’s disease is a common, yet underreported, condition that affects children between the ages of 6 and 14. It often presents as heel pain in one or both feet, which worsens after physical activity, particularly sports that involve running or jumping. This overuse injury typically occurs during periods of rapid growth, when the bones grow faster than the muscles and tendons, putting strain on the heel’s growth plate. 

Key Symptoms of Sever’s Disease 

• Heel Pain: Often worsens with physical activity, especially after running, jumping, or playing sports. 
• Swelling: Mild swelling in the heel may be present, though it is not always noticeable. 
• Tenderness: A child may experience tenderness when pressure is applied to the heel. 
• Pain with Squeeze Test: A clinical squeeze test, where the heel is gently squeezed on either side, often triggers pain, which is an indication of Sever’s disease. 
• Limitation in Activity: Children may begin to limit participation in sports or play due to pain. 

Diagnosing Sever’s Disease 

A physical exam and a detailed patient history are the primary methods used to diagnose Sever’s disease. The squeeze test, which involves applying gentle pressure to the sides of the heel, is usually sufficient to confirm the diagnosis. In some cases, imaging may be used to rule out other conditions, but this is typically unnecessary unless the diagnosis is unclear. 

Treatment Options 

When it comes to treating Sever’s disease, conservative management is typically the first line of treatment. While rest and lifestyle modifications are essential, physical therapy plays a crucial role in both the recovery and prevention of future episodes of heel pain. Physical therapy for Sever’s disease aims to reduce pain, improve flexibility, strengthen muscles, and correct any biomechanical issues that may be contributing to the stress on the heel. Here’s how physical therapy aids in the process:

1. Stretching and Flexibility Exercises

One of the key components of physical therapy for Sever’s disease is addressing muscle tightness and improving flexibility, particularly in the calf muscles (gastrocnemius and soleus). These muscles, which attach to the Achilles tendon, play a significant role in the force and tension placed on the heel. During growth spurts, the muscles and tendons may not stretch as quickly as the bones, which increases the pull on the heel and exacerbates pain. 

Physical therapists use stretching exercises to increase the length of these muscles, reducing the tension on the Achilles tendon and alleviating pressure on the heel’s growth plate. Calf stretches (like wall stretches or towel stretches) are commonly prescribed, along with stretches for the hamstrings and plantar fascia. These exercises are typically done in a gradual and controlled manner to ensure the muscles are lengthened without overstraining them.

2. Strengthening Exercises

As part of the rehabilitation process, strengthening exercises are also critical. While rest is important initially, muscle weakness can occur when a child is overly restricted. Physical therapy focuses on strengthening the muscles around the lower leg, ankle, and foot to reduce the strain on the heel and improve overall function. 

Eccentric strengthening exercises, such as heel raises (performed slowly and with control), help rebuild strength in the calf muscles and Achilles tendon. By strengthening these areas, physical therapy can help absorb the forces of impact during physical activity and prevent excess strain on the growth plate. In turn, these exercises promote better alignment and movement patterns, which is essential for long-term recovery.

3. Biomechanical Corrections

In addition to flexibility and strength, physical therapy can address any biomechanical issues that may contribute to Sever’s disease. For instance, children with issues like flat feet or high arches may place extra pressure on the heel, increasing the risk of developing Sever’s disease. Physical therapists can assess a child’s walking and running patterns, as well as their foot alignment, to identify potential contributing factors. 

If necessary, physical therapists may recommend custom orthotics (shoe inserts) to correct poor alignment and provide additional support. These orthotics can help redistribute forces more evenly across the foot and reduce excessive strain on the heel. Footwear modifications, such as shoes with better arch support and cushioning, are also a common part of physical therapy treatment to further protect the growing heel.

4. Manual Therapy and Soft Tissue Mobilization

In some cases, physical therapists use manual therapy techniques to help alleviate tightness and discomfort in the affected areas. This can include soft tissue mobilization or myofascial release, which involves hands-on techniques to relieve tension in the muscles and tendons around the heel. These techniques can help reduce pain, improve blood flow, and promote healing. 

Manual therapy is typically used in combination with other therapeutic modalities, such as ice therapy to reduce inflammation, or heat therapy to improve circulation and flexibility. These techniques enhance the body’s natural healing processes and can speed up recovery, especially when combined with strengthening and stretching exercises.

5. Gradual Return to Activity

Once pain and inflammation have decreased, physical therapy also focuses on helping children gradually return to physical activity. It’s crucial that children with Sever’s disease don’t rush back into high-impact sports too soon, as this can result in a recurrence of symptoms. Physical therapists will design a progressive activity plan that helps children rebuild strength and endurance while minimizing the risk of re-injury. 

This phased approach includes low-impact activities, such as swimming or cycling, to maintain fitness without placing undue strain on the heel. As the child becomes stronger and pain-free, the therapist will guide them through more intense activities, progressively working up to their regular sports routine. 

6. Education and Prevention

A critical aspect of physical therapy is patient education. Physical therapists take the time to educate both the child and their parents about the nature of Sever’s disease, its symptoms, and the importance of adhering to the treatment plan. They may also provide tips for preventing future injuries, such as proper warm-up and cool-down routines, the importance of appropriate footwear, and how to monitor activity levels to avoid overuse. 

Education empowers parents and children to make informed decisions about their physical activity, helping to ensure that Sever’s disease does not recur once the healing process is complete. Teaching children proper form during sports or activities can also reduce the strain placed on the growth plate and other vulnerable areas. 

Preventing Sever’s Disease 

Prevention of Sever’s disease is possible with the right strategies, particularly for children involved in high-impact sports. Coaches and parents can help reduce the risk by: 

• Educating About Symptoms: Understanding the signs and getting a timely diagnosis is essential for preventing prolonged pain and long recovery times. 
• Footwear and Equipment: Ensuring that your child’s shoes provide adequate support and cushioning can help reduce strain on the heel. 
• Activity Modifications: Minimizing activities that put excessive pressure on the heel and encouraging balanced fitness routines that include rest, flexibility, and strength training. 
• Strengthening and Stretching Exercises: Implementing preventative exercises focused on hamstring flexibility, calf stretches, and lower limb strengthening can help maintain muscle balance and prevent overuse injuries. 

Step Towards Healing from Sever’s Disease with Pro Staff 

At Pro Staff Physical Therapy, we specialize in helping children recover from Sever’s disease with a comprehensive, personalized treatment approach. Our expert team of physical therapists provides personalized treatment plans that focus on our patients’ personal needs. Using proven techniques to reduce pain, restore mobility, and prevent future episodes of heel pain, we ensure a safe and effective recovery process. 

If your child is experiencing heel pain or has been diagnosed with Sever’s disease, don’t wait to get the care they need. Schedule an appointment today and take the first step toward restoring your child’s active lifestyle.