Sever's Disease (Heel Pain)
What's Is Sever's Disease?
Sever's disease, also referred to as calcaneal apophysitis (inflammation of the growth center in the heel bone), is an overuse injury that causes pain, inflammation and tenderness in the heel area of active athletes. This condition is commonly seen in active, growing boys and girls who participate in running and jumping activities.
Two large muscles in the calf, the gastrocnemius and soleus, join together and become the Achilles tendon (heel cord). The Achilles tendon inserts into the growth area of the heel bone. These powerful muscles pull on the heel to push the foot down and propel the body forward during running and jumping exercises. The repetitive pulling of the Achilles tendon can overwork the growth center of the heel bone and lead to this overuse condition.
Are X-rays Necessary?
Radiographs (X-rays) may be ordered by your doctor to confirm the diagnosis or to exclude other problems. Often, the diagnosis is made based upon the clinical information and the physician’s experience. X-rays are more likely to be ordered if the condition affects only one side, or if there are other factors raising your physician’s concern to other possible diagnoses.
What Can Be Done?
The principles of treating Sever's disease include applying ice to the heel area, taking anti-inflammatory medicines as directed by the physician and modifying activities (see relief treatments). While this overuse condition may persist for two to three years, it does not lead to any problems later in life. In addition, invest in good running shoes. They often have built up heel cups that help to cushion the heel area with impact loading activities. Baseball and soccer shoes generally do not have well supported heel areas and a heel pad may need to be added.
Heel pads assist in cushioning the heel bone as it strikes the ground. The heel lift may also alter the mechanics slightly by raising the heel up. Heel cups that are commonly available in sporting goods stores usually are flimsy and simply flatten down after being worn a few times. Heel pads made of 3/8 inch felt or silicone stand up to considerably more wear.
For athletes such as gymnasts and dancers, where shoe modifications are not practical, there are other strategies that may help. Physical therapy may be ordered by the physician to instruct the athlete in proper calf and Achilles tendon stretching and strengthening exercises.
Relief Treatments
Ice: Icing can be a very effective anti-inflammatory treatment. The best time to apply ice is immediately after the workout, such as the car ride home from the game or practice field. One effective way is to apply an ice cup massage. Fill several styrofoam cups with water and freeze them. When frozen, tear off one inch around the cup’s rim to create a frozen snow cone. The ice should be applied directly to the sore area in a circular massaging motion until the area becomes numb, usually about 10 to 15 minutes. This can be repeated every 60 to 90 minutes, several times a day.
Medicine: Anti-inflammatory medicine or NSAIDS (non-steroidal anti-flammatory drugs) can be another effective treatment. Your physician may suggest an over-the-counter medicine such as ibuprofen (Motrin®, Advil®) or naproxen (Aleve®) or may prescribe a medicine for you. For those young athletes who can swallow pills, Aleve® works well, since it needs to be taken only twice a day (morning and night). It doesn’t need to be taken during school or right before workouts. Ibuprofen should be taken three times a day. Anti-inflammatory medicine should be taken for 10 to 14 days to allow the medicine to build up in your system to therapeutic levels. Taking medicine every now and then allows the levels in your system to drop, which decreases its effectiveness.
Printable brochure on Sever's Disease (En Español)