During AGS, and in specific reference to Sever?s disease, the heel bone grows faster than the Achilles tendon, resulting in an extremely tight Achilles tendon. Because the foot is one of the first
parts of the body to grow to full size, and because the heel is not a very flexible area, it is especially susceptible to injury. The Achilles tendon (also called the heel cord) is the strongest
tendon that attaches to the growth plate in the heel. Over time, repeated stress (such as impact activities) on the tight Achilles tendon causes the tendon to pull on and damage the growth plate in
the heel, resulting in swelling, tenderness, and pain.
Sever's disease is a common cause of heel pain in physically active growing kids. It usually occurs during the growth spurt of adolescence, the approximately 2-year period in early puberty when kids
grow most rapidly. This growth spurt can begin anytime between the ages of 8 to 13 for girls and 10 to 15 for boys. Peak incidences are girls, 8 to 10 years old. Boys, 10 to 12 years old.
Symptoms of calcaneal apophysitis may include Pain in the back or bottom of the heel, Limping, Walking on toes, Difficulty running, jumping, or participating in usual activities or sports, Pain when
the sides of the heel are squeezed.
A doctor can usually tell that a child has Sever's disease based on the symptoms reported. To confirm the diagnosis, the doctor will probably examine the heels and ask about the child's activity
level and participation in sports. The doctor might also use the squeeze test, squeezing the back part of the heel from both sides at the same time to see if doing so causes pain. The doctor might
also ask the child to stand on tiptoes to see if that position causes pain. Although imaging tests such as X-rays generally are not that helpful in diagnosing Sever's disease, some doctors order them
to rule out other problems, such as fractures. Sever's disease cannot be seen on an X-ray.
Non Surgical Treatment
stretching exercises can help. It is important that your child performs exercises to stretch the hamstring and calf muscles, and the tendons on the back of the leg. The child should do these
stretches 2 or 3 times a day. Each stretch should be held for about 20 seconds. Both legs should be stretched, even if the pain is only in 1 heel. Your child also needs to do exercises to strengthen
the muscles on the front of the shin. To do this, your child should sit on the floor, keeping his or her hurt leg straight. One end of a bungee cord or piece of rubber tubing is hooked around a table
leg. The other end is hitched around the child's toes. The child then scoots back just far enough to stretch the cord. Next, the child slowly bends the foot toward his or her body. When the child
cannot bend the foot any closer, he or she slowly points the foot in the opposite direction (toward the table). This exercise (15 repetitions of "foot curling") should be done about 3 times. The
child should do this exercise routine a few times daily.
Because there are several theories as to the actual cause of the disease, there is no definitive answer on prevention. Experts agree, though, that youth athletes can help minimize the risk of Sever's
disease by maintaining good joint and muscle flexibility while engaging in sports or physical activities.