Athletic Injury Update: Sever’s Disease

Sever’s Disease or “calcaneal apophysitis” (a-pof-i-sight-is) is heel pain experienced by a lot of athletes that are involved in high impact sports. Essentially, those big medical words mean “Inflammation at the growth plate of the heel bone).  Heel pain typically begins around the age of 10 and can be intermittent throughout growth, until the age of 15-16.

ANATOMY:

Severe’s Disease involves the Achilles tendon, the thick tendon that is comprised of the calf muscles: the gastrocnemius and soleus muscles.  The Achilles tendon inserts onto a portion of the calcaneus, or the heel bone, called the calcaneal tuberosity.  Heel pain results from an increase in shearing stress on the Achilles tendon during plantar flexion, or pointing, of the foot.

CAUSES:

Most often, this is caused in physically active children, in particular those involved with high impact sports or a lot of running.  Gymnasts, dancers, basketball and volleyball players are particularly at risk for this injury. Because there is repetitive and high amounts of stress on the Achilles tendon at the portion of the bone that it attaches to on the heel, inflammation sets in and causes pain at this common growth spot in young children.

Some particular causes include:

1. Growth spurts
2. High impact activity
3. Poor fitting shoes
4. Soft cartilage

HISTORY, SIGNS & SYMPTOMS:

1. Heel pain in 8-15 year olds; usually disappears by age 16 as the growth centers have closed.
2. Very common in sports with a great deal of running, especially stop and go movements.
3. High impact activity.
4. Local swelling may be noticeable.
5. Pain with squeezing the heel.
6. X-Ray is not usually indicated unless an avulsion fracture is thought to have occurred (tendon tearing away from the bone).

MANAGEMENT:

1. REST à Activity modification is difficult at this point in a young athlete’s life, however is crucial to full recovery.
2. Properly fitting shoes that are not too small or too tight. Shoes should be supportive in nature and should be stressed to be worn while indoors. No bare feet if possible. No flip-flops!
3. HEEL SUPPORT àHeel pads for cushioning during the day time or during physical activity. Orthotic heel support during regular day hours.
4. Ice-baths after activity
5. Patient education & self restriction are important
6. NUTRITION à water for tissue hydration, bromolain and vitamin C
7. Soft tissue release of gastrocnemius and soleus muscles, tibialis anterior/posterior, and side left muscles as well (peroneii muscles).
8. Proper alignment of ankle joints, foot joints, and hips/pelvis for leg length equality.

PROGNOSIS:

Unfortunately, most athletes that suffer from this injury are high profile athletes that are spending a lot of time on the courts or in the gym.  This can often be a chronic injury that they will suffer through until the growth center has closed around the age of 15-16.  Occasionally, the Achilles tendon can separate from the bone, called an avulsion fracture, however this is really only in severe cases. Chiropractors and physiotherapists can help to manage the symptoms while the young athlete is competing.

Dr. Sarah Ytsma is currently practicing chiropractic in both Chatham and Blenheim. She takes a special interest in athletic injuries, as athletics were a large part of her high school and post-secondary school careers. She played 4 years of varsity softball as a fastball pitcher for the Wayne State University Warriors before attending chiropractic school in St. Louis, MO. While completing her chiropractic internship, Dr. Sarah was granted a position with Logan College of Chiropractics “Biofreeze Sports & Rehabilitation Clinic” as a senior intern to work with athletes from Mizzou and local high schools and colleges. You can
find more info on Dr. Sarah at www.drsarahytsma.ca.