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Does Severs Disease Call For Surgical Treatment?
Overview


Sever?s disease is a heel problem that is the most common cause of heel pain that commonly occurs in children. It is caused by repetitive use and overuse of the heel while it is still growing, therefore is more common in active children and teenagers. Despite the name, Sever?s Disease like Osgood- Schlatter disease is caused by overuse and is not a disease.


Causes


This condition most commonly occurs due to repetitive or prolonged activities placing strain on the heel's growth plate, typically during a period of rapid growth. These activities (or sports) usually involve excessive walking, running, jumping or hopping. Severs disease may also be more likely to occur following a poorly rehabilitated sprained ankle, in patients with poor foot biomechanics or those who use inappropriate footwear. In young athletes, this condition is commonly seen in running and jumping sports, such as football, basketball, netball and athletics.


Symptoms


Sever?s disease is more common in boys. They tend to have later growth spurts and typically get the condition between the ages of 10 and 15. In girls, it usually happens between 8 and 13. Symptoms can include pain, swelling, or redness in one or both heels, tenderness and tightness in the back of the heel that feels worse when the area is squeezed. Heel pain that gets worse after running or jumping, and feels better after rest. The pain may be especially bad at the beginning of a sports season or when wearing hard, stiff shoes like soccer cleats. Trouble walking. Walking or running with a limp or on tip toes.


Diagnosis


It is not difficult for a doctor to diagnose Sever's disease in a youngster or teenager. A personal history and a physical examination are usually all it takes to determine the cause of heel pain.


Non Surgical Treatment


Cold packs: Apply ice or cold packs to the back of the heels for around 15 minutes after any physical activity, including walking.


Shoe inserts: Small heel inserts worn inside the shoes can take some of the traction pressure off the Achilles tendons. This will only be required in the short term.


Medication: Pain-relieving medication may help in extreme cases, but should always be combined with other treatment and following consultation with your doctor).


Anti-inflammatory creams: Also an effective management tool.


Splinting or casting: In severe cases, it may be necessary to immobilise the lower leg using a splint or cast, but this is rare.


Time: Generally the pain will ease in one to two weeks, although there may be flare-ups from time to time.


Correction of any biomechanical issues: A physiotherapist can identify and discuss any biomechanical issues that may cause or worsen the condition.


Education: Education on how to self-manage the symptoms and flare-ups of Sever?s disease is an essential part of the treatment.


Exercise


For children with Sever's disease, it is important to habitually perform exercises to stretch the hamstrings, calf muscles, and the tendons on the back of the leg. Stretching should be performed 2-3 times a day. Each stretch should be performed for 20 seconds, and both legs should be stretched, even if the pain is only in one heel. Heel cups or an inner shoe heel lifts are often recommended for patient suffering from Sever's disease. Wearing running shoes with built in heel cups can also decrease the symptoms because they can help soften the impact on the heel when walking, running, or standing.
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