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May202015

Severs Disease The Facts

Overview


Sever's disease, also known as calcaneal apophysitis, is an inflammatory condition of the growth plate of the heel (calcaneus). Sever's disease is seen during periods ofSever's_Disease_x-ray active bone growth, particularly between the ages of 10 and 14 years old. Sever's disease is a self limiting condition, meaning that all cases of Sever's disease will disappear once bone growth is finalized and the growth plate of the heel closes. Skeletal maturity and closure of the growth plate occurs for most children at 15-16 years of age. The onset of Sever's Disease is insidious and found more in boys than girls.


Causes


Having flatfeet or very pronated feet can make one prone to Sever's disease. But also patient?s that have a very high arch foot structure tend to have a very high shock and high impact heel strike. This also puts extra stress on the heel and apophysis.


Symptoms


Pain is usually related to activity levels. In most cases the posterior aspect of the calcaneus will be tender. Checking both the medial and lateral aspects of the posterior portion of the growth plate will often show tenderness. Occasionally, the plantar aspect may be tender or both of these locations may be found to be tender. Frequently the Achilles tendon is tight and there may have been a recent increase in activity. The factors contributing to this disorder are similar to those causing plantar fasciitis, but a tight Achilles tendon appears to be a greater contributor than pronation.


Diagnosis


A Podiatrist can easily evaluate your child?s foot, lower limbs and muscular flexibility, to identify if a problem exists. If a problem is identified, a simple treatment plan is put in place. Initial treatment may involve using temporary padding and strapping to control motion or to cushion the painful area and based on the success of this treatment, a long-term treatment plan will be put in place. This long-term treatment plan may or may not involve Foot Supports, Heel Raises, muscle stretching and or strengthening.


Non Surgical Treatment


Massage the calves gently from the knee to the heel, being especially careful around the Achilles? tendon, as this will be extremely tight and tender. During this massage, flex and point the foot through normal pain-free ranges of motion to increase flexibility while massaging. Massage every other or every third day, making sure your young athlete is not still sore before massaging again. If you?re unsure how to massage, find someone in your area that uses Graston technique or Active Release Therapy for best results. Stretch your athlete?s calves. This is the most overlooked aspect of treatment for Sever?s Disease and this needs to be done every day after practice, and when first starting we recommend 2-3 times per day, allowing gravity to pull heel down, never forcing the stretch. Ice your heels, but don?t just put an ice pack there. Use a cold water soak to fully immerse the foot and calves up to the knee. We recommend using a rubbermaid can found here. Soak for 10-15 minutes. The water does not have to be frigid, just cold. Use cold water from the tap, insert the foot, then add some ice to help bring down the temperature. When your athlete is experiencing pain, ice every hour, on the hour, for as many times as possible in one day. Make sure the heel/calves are body temperature before beginning again. Support the arches. This is what has been shown in studies to reduce pain in young athletes with Sever?s Disease. If you miss out on this one, you miss out on relieving your athletes pain.

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