Sever's disease

Sever's Disease, otherwise known as calcaneal apophysitis is an inflammation of the growth plate in the heel of growing children, typically adolescents. The condition presents as pain in the heel and is caused by repetitive stress to the heel and is thus particularly common in active children. It usually resolves once the bone has completed growth or activity is lessened.

Eponym
It is named for James Warren Sever (1878–1964), an American Orthopaedic Surgeon, who characterized it in 1912. Dr Sever had "The Principles of Orthopaedic Surgery" published in 1940 by The Macmillan Company.

Symptoms
The most prominent symptom of Sever's disease is heel pain which is usually aggravated by physical activity such as walking, running or jumping. The pain is localised to the posterior and plantar side of the heel over the calcaneal apophysis. Sometimes, the pain may be so severe that it may cause limping and interfere with physical performance in sports. External appearance of the heel is almost always normal, and signs of local disease such as edema, erythema (redness) are absent. The main diagnostic tool is pain on medial- lateral compression of the calcaneus in the area of growth plate, so called squeeze test. Foot radiographs are usually normal. Therefore the diagnosis of Sever's disease is primarily clinical.

Cause
Sever’s disease is directly related to overuse of the bone and tendons in the heel. This can come from playing sports or anything that involves a lot of heel movement. It can be associated with starting a new sport, or the start of a new season. Children who are going through adolescence are also at risk of getting it because the heel bone grows quicker than the leg. Too much weight bearing on the heel can also cause it, as can excessive traction since the bones and tendons are still developing. It occurs more commonly in children who over-pronate, and involves both heels in more than half of patients.

Treatment
Treatment may consist of one or more of the following:
 * Elevating the heel
 * Stretching hamstring and calf muscles 2–3 times daily
 * Using R.I.C.E. (Rest, Ice, Compression, Elevation)
 * Foot orthotics
 * Medication
 * Physical therapy
 * Icing daily (morning)
 * Heating therapy
 * Open back shoe are best and avoid high heel shoe

Recovery
Sever’s disease is self-recovering, meaning that it will go away on its own when the foot is used less or when the bone is through growing. The condition is not expected to create any long-term disability, and expected to subside in 2–8 weeks. Some orthopedic surgeons will put the affected foot in a cast to immobilize it.

However, while the disease does subside quickly, it can recur, for example at the s It is more common in boys, although occurs in girls as well. The average age of symptom onset is 9–11.

Prevention

 * Maintain good flexibility through stretching exercises
 * Avoid excessive running on hard surfaces
 * Use quality, well-fitting shoes with firm support and a shock-absorbent sole