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May192015

Will Severs Disease Often Need To Have Surgery?

Overview


During a growth spurt, your child?s heel bone grows faster than the muscles, tendons, and ligaments in her leg. In fact, the heel is one of your child?s first body parts to reach full adult size. When the muscles and tendons can?t grow fast enough to keep up, they are stretched too tight. If your child is very active, especially if she plays a sport that involves a lot of running and jumping on hard surfaces (such as soccer, basketball, or gymnastics), it can put extra strain on her already overstretched tendons. This leads to swelling and pain at the point where the tendons attach to the growing part of her heel.


Causes


When a baby is born, most of the bones are still cartilage with only some starting to develop into bone. When the heel (calcaneus) starts to develop bone, there is generally one large area of development that starts in the center of the cartilage heel. This area of bone spreads to 'fill up' the cartilage. Another area of bone development (ossification) occurs at the back of the heel bone. These two areas of developing bone will have an area of cartilage between them, this is how the bone grows in size. At around age 16, when growth is nearly complete, these two bony areas fuse together. Sever's disease or calcaneal apophysitis is usually considered to be due to damage or a disturbance in this area of growth.


Symptoms


Chief complaint is heel pain which increases pain during running and jumping activities. Pain is localized to the very posterior aspect of the heel. Pain is elicited only with weightbearing. Mild involvement is present if pain is brought on only with running during sports. The symptoms can be severe, with pain (and possibly limp) with activities of daily living (ie walking).


Diagnosis


The doctor may order an x-ray because x-rays can confirm how mature the growth center is and if there are other sources of heel pain, such as a stress fracture or bone cyst. However, x-rays are not necessary to diagnose Sever?s disease, and it is not possible to make the diagnosis based on the x-ray alone.


Non Surgical Treatment


The primary method of treating Sever?s disease is taking time off from sports and other physical activities to alleviate the pressure on the heel bone. During the healing period, your child?s doctor may also recommend physical therapy or any type of exercise that involves stretching and strengthen leg muscles and tendons. Wrapping ice in a towel and placing it under the child?s heel will also help to alleviate and reduce pain and swelling.

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