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Conditions of the Foot
by Dr. Mark H. Tompkins

 

Severs Disease (Calcaneal Apophysitis)

Introduction

Severs Disease (SD), or Calcaneal Apophysitis, is an inflammatory process that occurs along the growth plate of the heel bone (calcaneus). The growth plate is the area of a bone where progressive bone growth (ossification) occurs. It is true ‘Growing Pain’. Another common name for this inflammatory process which occurs in other areas of the body is referred to as osteochondrosis-the most common being Osgood-Schlatter Disease. For more information regarding osteochondrosis, please see http://en.wikipedia.org/wiki/Osteochondrosis .

SD is acute (or chronic) inflammation, and resultant pain, along the growth plate of the heel bone. It most commonly occurs in adolescents between the ages of 8-14, but can occur in any age prior to skeletal maturity (15-18 yrs.) Although there are many causes of heel pain, SD makes-up the majority of children who suffer from pain at the back of the heel. SD most commonly occurs during significant (or immediately proceeding) skeletal and/or foot growth. It is very common in active children, especially those involved in running and/or jumping-related activities or sports.

Pathology/Diagnosis

The Achilles tendon attaches at the back of the heel bone in an area involved with the growth plate. As skeletal growth and elongation takes place, many times the soft tissues (muscles, tendons, and ligaments) cannot keep-up with this process. Increased pressure can occur along the growth plate and many times leads to SD. There are some hereditary considerations, as well as biomechanical problems that can occur within the leg, foot, and ankle that may predispose some children to develop SD.

Children with ‘mild’ SD initially complain of pain at the back of the heel. This occurs especially after periods of increased activity, excessive barefoot and/or sandal wear, or recent increase in height, weight, or/and shoe size. If untreated, patients can develop ‘moderate’ SD and typically begin to limp, either during or after activity. Children with moderate SD (especially athletes) will have pain and limp, but normally want to continue their activities. ‘Severe’ cases of SD usually lead to increased and persistent pain with any level of activity, significant limping, and usually cessation of activities due to the consistent pain.

SD can occur in either foot without predilection, and in the majority of cases is unilateral (occurring in only one foot). Bilateral (both feet) cases can also occur, but is usually the result of non/inappropriate treatment of the symptomatic contra lateral (other) foot.

A simple home-test to determine if SD may be present in your child is to squeeze the affected heel from side-to-side towards the back. If relatively little pressure causes pain or discomfort, SD is most likely the cause. Also, many times, standing on the toes (‘tippy-toes’) will cause discomfort and/or pain at the back of the heel.

Treatment

Mild cases of SD can usually be treated successfully with a combination home-treatment plan. This consists of temporarily limiting (excessive) physical activity; rigorous-consistent stretching/strengthening exercises (See Figures below); appropriate and supportive athletic shoes; heel lifts and/or shoe inserts; ice-massage after activity; no barefoot/sandal/flip-flop walking; and OTC oral anti-inflammatory medications.

Moderate cases of SD are treated with limiting or cessation of physical activities; some level of immobilization ranging from taping, to bracing, to a high-top walker; physical therapy; OTC (or sometimes Rx) anti-inflammatory medication. Once the pain has been reduced significantly, initiation of the above noted (mild case) treatments should proceed.

Severe cases of SD are most successfully treated with complete cessation of all (extra-curricular) physical activities, and either the application of a BK (below the knee) Cast, or High-top Walker. The majority of cases can be treated with allowing weight-bearing, but more resistant cases may need the addition of crutches. However, this is extremely rare.

Reoccurrence and Prevention

There is are relatively high reoccurrence rate with SD, especially in children who are extremely active, participate in running and/or jumping sports, have predisposing biomechanical problems, like to go barefoot or wear flip-flops/sandals, or are over weight.

Helpful actions in preventing reoccurrence are to wear supportive shoes as much as possible and limit barefoot/sandal wear. Also, compliant use of heel lifts and/or shoe inserts if prescribed by your doctor is important. However, the most important factor is an appropriate, consistent, and rigorous stretching/strengthening regimen. This is important for all individuals with SD, but mandatory of all patients who participate in strenuous extra-curricular activities and sports.

Stretching/Strengthening Exercises

Calf stretch Hamstring stretch Strengthening exercise using a bungee cord or rubber tubing

foot exercise 1
foot exercise 2
foot exercise 3
Figure 1
Figure 2
Figure 3
Heel Cord Stretch
Hamstring Stretch
Leg-Muscle Strengthening

Stretching Exercises (Figures 1, and 2)

Each stretch should be performed ONE foot/leg at a time; Hold each stretch for a count of TEN, then relax for 2-3 seconds. This is ONE REPETITION. Do (at least) TEN REPETITIONS (which is a SET), twice a day, especially AFTER ANY EXERCISE OR ACTIVITY. One important thing to remember “You can’t stretch too much”. The more you stretch (repetitions), and the more often (sets), the better chance you will have to prevent future problems

Strengthening Exercises (Figure 3)

Use an elastic band in an ‘isometric’ manner to strengthen the muscles on the top of your lower leg. Pull your foot back against the band and hold for approximately 3-5 seconds, and repeat 8-10 times. More stretch on the band will increase the resistance and resultant strength of the muscles.


 


OTHER COMMON
FOOT PROBLEMS

Athletes Foot

Bio-Mechanical Pain

Bunions

Calluses & Corns

Diabetic Foot

Flat Feet

Hallux Limitus/Rigidus

Hammer Toes

Heel Pain/Heel Spur

Ingrown Nails

Metatarsalgia

Morton's Neuroma

Neuropathy

Orthotics

Plantar Fasciitis

Plantar Warts

Running Injuries

Sclerosing Injection Treatments

Sesamoiditis

Severs Disease

Shin Splints

Sweaty Feet/Odor

Toenail Fungus

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Dr. Mark Tompkins | 4402 Vance Jackson, Suite #146 | Phone: 210-341-2202

Copyright © 2001-2009 Dr. Mark H. Tompkins.  All rights reserved.