Sever’s (inflammatory response of the attachment of the Achilles’ tendon to the heel bone) is the most common cause of heel pain in young children. It is particularly common in boys aged 8-15 years of age. Sever’s is very common in the sports of football and netball.
Symptoms associated with Sever’s include:
- gradual increase in pain over prolonged period
- pain increases that a limb occurs when playing sport
- worse barefoot, particularly in the morning
- sore to squeeze the region
Inflammation at the attachment site of the Achilles tendon and the heel bone occurs because of excessive pulling of the Achilles. This causes it to separate from the heel, fibre by fibre.
There are a number or reasons why constant tearing of the Achille’s away from the heel occurs leading to inflammation:
- Growth of the child has made the bones longer than the muscles
- Excessive over-pronation (flatterning of feet)
- Tight calves
- Poor footwear
- Increased sport
Sever’s is always treated conservatively. The condition will usually settle after 6-12 months, however, there have been cases where it has taken as long as 2 years. The first objective is to ease the initial inflammation. Regular daily icing and massage will achieve this. Following this, decreasing the difference between muscle and bone length as well as providing adequate arch is the key as it stops the ‘vicious’ cycle. To rebalance the length of muscles and bone, stretching the calves is very important as well as getting the feet in the correct football boots and shoes. To also accelerate this process, heel lifts are provided. The taping simulates customized prescription orthoses, which provides the required arch support. Correct footwear also optimizes the level of correction of these devices. Your Podiatrist can advise of activity adjustments to relieve the pressure on the heel region. A corticosteroid injection and surgery are not considered options.
