Sever’s disease is the most common cause of heel pain in children and adolescents. In fancy terms it is called “calcaneal apophysitis”, simply meaning irritation of the growth plate on the heel bone caused by a few different things. This growth plate in the heel does not typically fuse until the age of 15-17, leaving it vulnerable to injury usually between the ages of 8-15.
What is Sever’s disease?
The growth plate mentioned above is located where the achilles tendon inserts into the heel. This growth plate can become irritated, leading to inflammation, and then consequently causing pain for the young footballer. Irritation is primarily caused by excessive stress caused by repeated impact pressure and forces on the still-developing growth plate/heel bone.
What are the risk factors for developing Sever’s disease?
The development of Sever’s disease is largely associated with growth, as growth is directly proportional to the amount of stress placed on the growth plate. Therefore, during periods of a growth spurt, the likelihood of symptoms developing is much higher. Other than growth, football itself places youth athletes at a higher risk due to the nature of the game requiring repetitive running and jumping - both of which are very calf heavy! Other things to consider are footwear and playing surface - footballers should ensure their boots are cushioned enough to provide some support and take into account playing on hard surfaces especially during winter months on frozen pitches!
What are the symptoms of Sever’s disease?
Sever’s disease can appear in just one or both legs - up to 60% will be on both! Other common features include:
Pain at the heel which is increased when weight bearing, running and jumping
Tenderness when squeezing the heel from either side
A limp may be present after physical activity due to pain
Tightness of the achilles tendon
There may be slight swelling, but this is relatively uncommon
How do we manage Sever’s disease?
Activity modification - this means avoiding aggravating activities guided by the levels of pain. Essentially, players can train and play as much as their pain allows but mustn't continue to play football if their symptoms are getting worse. Activity can be modified by reducing the frequency, intensity or duration of football sessions.
Insoles - heel cup insoles with arch support cushions the affected area to help with shock absorption
Stretching - stretching the arch of the foot and calf muscles to improve range of motion available at the affected ankle(s)
Strengthening - strengthening of the muscles around the calf and also the hip and core that may be weak due to a rapid growth spurt
Here at SV Sports Therapy, we can help young footballers and athletes to deal with growth-related injuries by assessing their individual needs, using a variety of treatment methods and providing bespoke rehabilitation and management plans to get them safely back onto the pitch pain-free.
Did you know that alongside SV Sports Therapy, Emily works alongside the academy at Watford Football Club, providing pitch-side first aid, injury assessment and injury rehabilitation to players aged 9-16? She knows her stuff!
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