Sever’s Disease is a painful inflammatory condition affecting the Achilles tendon insertion at the calcaneal apophysis. This condition is a common cause of posterior heel pain in active adolescents. Sever's Disease is often a diagnosis of exclusion dependent on the location of pain, patient age, and clinical presentation.
Common Facts About Sever’s Disease
1. The mean time to return-to-play of the affected athletes is around two months.
2. Commonly found in athletically active populations between the ages of 8 and 14.
3. There is a slightly higher incidence in males.
4. These patients often present after beginning a new sports season.
5. Activities requiring running and jumping, including soccer, basketball, gymnastics, and track & field, are most closely associated with the development of Sever’s Disease.
6. Symptoms are on both sides in 60% of cases.
Why Does Sever’s Disease Affect Children?
In children and adolescents, the epiphyseal growth plate is 2-5 times weaker than in adults. Children are more likely to suffer epiphyseal injuries from stressors that would likely cause sprains and strains in adults. The apophysis is most vulnerable during periods of rapid adolescent growth. As bones lengthen rapidly, soft tissues become tighter and produce excessive stress on their bony attachments. Like other traction apophysitis', Sever's Disease is thought to be caused by diminished resistance to shear stress at the apophyseal growth plate. The calcaneal apophysis is subject to significant shear loads due to its vertical orientation and direction of pull from the powerful gastroc/soleus. Severs Disease is the second most common traction apophysitis behind Osgood Schlatters (anterior knee area pain)
Chiropractic Treatment of Acute Sever’s Disease
1. The first goal is to return a patient to pain-free activity. Ice, especially pre- and post-sport, and anti-inflammatory therapies are beneficial initially.
2. Address calf tightness with myofascial release and stretching.
3. Evaluate shoes and limit barefoot walking during the acute phases of injury.
4. Orthotics or inserts may be required to improve faulty foot biomechanics. The consistent use of ½ inch heel lifts can ease shear strain from tight calf muscles.
5. Kinesiotaping of the posterior calf or heel may provide symptom relief.
As youth sports become more competitive, adolescent athletes are subject to higher physical demands, and their developing bodies sometimes fail to keep up with the expectations of parents and coaches. Activity modification is often necessary to reduce symptoms, including decreasing the frequency and intensity of exercise. Limiting running and jumping may be required during the acute or painful phase of injury recovery. Low-impact cross-training with a bike or in the pool may be beneficial. Calcaneal apophysitis (Severs disease) is a self-limiting condition which will resolve overtime if managed correctly.
Exercises For Post-Acute Sever’s Disease
Treatment should shift to strengthening to improve biomechanics and minimize recurrence. Typically, symptoms resolve within 2 to 8 weeks of initiating rest and conservative treatment. It is time to build the athlete’s to return to their respective sports. Exercises should have a priority on ankle and foot strengthening.
Dr. Mike Hadbavny
Chiropractor, Sports Sciences Resident RCCSS(C)
If you are interested in learning more about how chiropractic care can be effective for your particular condition or health goals, contact Dr. Mike Hadbavny at 250-881-7881 today to make an appointment and discover the many benefits of seeing a chiropractor in Victoria BC. Contact us today.