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Physiotherapy For Severs Disease

May 21, 2015
Overview

It is thought to be a traction injury, where the Achilles tendon and Plantar fascia pull in opposite directions. Sever?s occurs in children aged 8 to 16 years old. In children, the heel bone is made up of 2 bones, with a growth plate of cartilage in between the sections, holding these 2 bones together. As the cartilage expands, the edges of it eventually turn to bone, and finally the gap closes. This usually occurs within the first 13-15 years of life. However, because these bones are connected by cartilage they are weaker than normal bones. This is why they are very vulnerable to injury.

Causes

There are many contributing factors that cause strain across the growth plate, making your child prone to developing Sever?s disease. These include repeated minor trauma to the growth plate from running or jumping sports, tight calf or hamstring muscles, rapid growth spurts can lead to the leg muscles becoming tight, increasing tension on the growth plate, tight Achilles tendon, the Achilles tendon attaches to the back of the heel adjacent to the growth plate, poor foot posture, may increase the strain on the growth plate, footwear with a very low heel pitch (eg soccer boots), unsupportive or unstable footwear with poor shock absorption at the heel, running or playing sport on hard surfaces.

Symptoms

A few signs and symptoms point to Sever?s disease, which may affect one or both heels. These include pain at the heel or around the Achilles tendon, Heel pain during physical exercise, especially activities that require running or jumping, worsening of pain after exercise, a tender swelling or bulge on the heel that is sore to touch, calf muscle stiffness first thing in the morning, limping, a tendency to tiptoe.

Diagnosis

Sever?s disease can be diagnosed based on the symptoms your child has. Your child?s doctor will conduct a physical examination by squeezing different parts of your child?s foot to see if they cause any pain. An X-ray may be used to rule out other problems, such as a broken bone or fracture.

Non Surgical Treatment

A doctor, sports therapist or physiotherapist can apply a plaster cast or boot if the child is in severe pain. This may be worn for a few days or even weeks and should give relief of pain for a while. Carry out a full biomechanical assessment. This may help to determine if any foot biomechanics issues are contributing to the condition. Orthotics or insoles can be prescribed to help correct over pronation or other biomechanics issues. Prescribe anti-inflammatory medication such as ibuprofen to reduce pain and inflammation. This will not be prescribed if asthma the child has asthma. In persistent cases X-rays may be taken but this is not usual. A doctor, sports therapist or physiotherapist will NOT give a steroid injection or operate as these are not suitable treatment options. The condition will usually settle within 6 months, although it can persist for longer.

Exercise

The following exercises are commonly prescribed to patients with Severs disease. You should discuss the suitability of these exercises with your physiotherapist prior to beginning them. Generally, they should be performed 1 - 3 times daily and only provided they do not cause or increase symptoms. Your physiotherapist can advise when it is appropriate to begin the initial exercises and eventually progress to the intermediate, advanced and other exercises. As a general rule, addition of exercises or progression to more advanced exercises should take place provided there is no increase in symptoms. Calf Stretch with Towel. Begin this stretch in long sitting with your leg to be stretched in front of you. Your knee and back should be straight and a towel or rigid band placed around your foot as demonstrated. Using your foot, ankle and the towel, bring your toes towards your head as far as you can go without pain and provided you feel no more than a mild to moderate stretch in the back of your calf, Achilles tendon or leg. Hold for 5 seconds and repeat 10 times at a mild to moderate stretch provided the exercise is pain free. Calf Stretch with Towel. Begin this exercise with a resistance band around your foot and your foot and ankle held up towards your head. Slowly move your foot and ankle down against the resistance band as far as possible and comfortable without pain, tightening your calf muscle. Very slowly return back to the starting position. Repeat 10 - 20 times provided the exercise is pain free. Once you can perform 20 repetitions consistently without pain, the exercise can be progressed by gradually increasing the resistance of the band provided there is no increase in symptoms. Bridging. Begin this exercise lying on your back in the position demonstrated. Slowly lift your bottom pushing through your feet, until your knees, hips and shoulders are in a straight line. Tighten your bottom muscles (gluteals) as you do this. Hold for 2 seconds then slowly lower your bottom back down. Repeat 10 times provided the exercise is pain free.

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