Orthopedics and traumatology

If your child has a sore heel, he may suffer from Sever's disease


The sever's disease It is a frequent growth pathology in children between the ages of 8 and 15, and that occurs especially in those who practice a load-bearing sporting activity (basketball, tennis, football, dance, running, jumping ...) with a high frequency and that manifests when the child's heel hurts. Is it something serious? What should we do as parents? We will tell you!

It is also called Calcaneal Apophysitis, since it is in the back of the heel bone or calcaneus where we find the physis or growth plate. This becomes inflamed due to being subjected to repetitive microtraumas, produced by the impact of the heel on the ground and to traction forces exerted by the insertion of the Achilles tendon, the short plantar flexors of the foot and the plantar aponeurosis.

The growth plates are weaker areas than the rest of the bone and, therefore, more sensitive to impacts. During 'pulls', bones sometimes grow faster than tendons, causing the tendons to tighten and irritate the insertion sites. Being overweight or gait problems (especially the calcaneal valgus) can cause or aggravate this pathology.

Among the warning signs, the progressive pain in one or both heels stands out, almost always during or after sports practice and that decreases or subsides with rest. It usually evolves into more acute pain, which persists even without exercise and can sometimes radiate towards the calves or the sole of the foot. Antalgic tiptoe gait is also likely to appear.

X-rays are not usually necessary, unless you want to rule out other types of problems that can cause similar symptoms, such as stress fractures or tumors. The diagnosis is clinical. The pain is reproduced or worsened when compressing the back of the heel with the fingers or when walking on the heels. Sometimes it is also annoying when performing a dorsiflexion of the foot, which stretches the muscles of the posterior chain. Treatment of this pathology can include:

- Physiotherapy
The objective that is sought with the different treatments is to reduce inflammation. The physiotherapist can use electrotherapy, ultrasound or Indiba and, also, myofascial techniques, stretching of the posterior muscle chain, massage to relax the tense muscles, but not in the heel, since it could irritate the area.

Depending on the results of the evaluation, it is sometimes necessary to perform exercises to strengthen the muscles that are antagonistic to the affected one, that is, that of the anterior part of the leg (tibialis anterior and extensors of the toes). We can use an elastic band around the back of the foot and have the child perform dorsiflexion movements of the foot (bringing the toes up, resisted by the rubber).

- Anti-inflammatory and or analgesics
They should not be abused, since they can cause the child to notice less pain, return to impact activities early and delay recovery. If the pain is very acute, they will help to avoid an antalgic walk on tiptoe.

- Heel pads
They are a double-edged sword. Silicone ones can reduce pain by cushioning the support of the heel, but at the same time they produce a shortening of the posterior chain that increases its tension, which could chronify the pathology. They can also alter the footprint, causing the weight to fall more on the ball of the foot and causing a postural imbalance. On the other hand, they do not correct muscle-tendon stiffness either.

- Sports rest
This point is essential for recovery. Without rest it is very difficult for the inflammation to subside.

- Templates
Depending on the intensity and duration of the discomfort, it would be advisable to visit a sports podiatrist, who makes a static and dynamic study of the footprint, and adapts and monitors the insole as the symptoms improve.

- control
Ask the coaches to monitor the sporting gesture, since sometimes a bad technical execution is the one that favors bad support.

The evolution of sever's disease towards healing is highly variable over time. It can take several months for the ossification nuclei of the calcaneus to disappear, or it can stop hurting, although there is still enough growth to occur. This will depend on each specific case.

To avoid relapses, it is advisable to adjust the time of physical activity, ensuring the necessary rest to avoid irritating the area and maintain joint flexibility by stretching the muscle chains. Thus we will not lose what has been gained in physiotherapy.

First of all, it is necessary to explain to the parents and the child that Although it is not a serious disease, you have to be patientas your recovery may be slower than we would like.

You can read more articles similar to If your child has a sore heel, he may suffer from Sever's disease, in the category of Orthopedics and on-site traumatology.

Video: Severs Disease (September 2020).