The calcaneus epiphysis is a growth centre where the Achilles tendon and the plantar fascia join the heel. It appears for the first time in children aged 7 to 8 years. At 12 to 14 years, the growth centre matures and fuses with the heel bone. Lesions can be caused by excessive tension in the Achilles tendon and plantar fascia or by a direct impact on the heel. Excessive tension in this growth centre can cause heel irritation, also called Sever’s disease.
Athletes with Sever’s disease are generally between 9 and 13 years old and participate in sports that involve running or jumping such as football, football, basketball, baseball and gymnastics. The typical complaint is heel pain that develops slowly and occurs with activity. The pain is usually described as a bruise. Rarely there is visible swelling or bruising. The pain usually gets worse when running in sports shoes or with heels that have limited heel lift, cushioning and arch support. The pain usually disappears with rest and rarely occurs in low-impact sports such as cycling, skating or swimming.
A physical examination of the heel will show tenderness above the back of the heel, but not in the Achilles tendon or in the plantar fascia. There may be stiffness in the calf muscle, which contributes to heel strain. Heel tendons stretch more in patients with flat feet. There is a greater impact force on the heels of athletes who have stiff feet with a high arch.
The doctor may request an x-ray as this can confirm the maturity of the growth center and if there are other areas of heel pain, such as a fatigue fracture or a bone cyst. However, an x-ray is not needed to diagnose Sever’s disease since it is not possible to make such a diagnosis based solely on the x-ray.
Other conditions that can cause heel pain
Heel pain can also be caused by a heel fatigue fracture, bursitis, tendonitis, bone cysts and joint disorders. If the athlete does not actively practice impact sports or is not between 9 and 13 years old, other conditions should be considered.
The following are different treatment options: Rest and modify the activity.
Run less and limit high impact activity to rest your heel and reduce pain. Play one sport at a time where you run or jump. Replace low impact cross-training activities to maintain cardiovascular health. These can be cycling, swimming, the use of a climber or an elliptical machine, rowing, or inline skating. Reduce inflammation Place ice for at least 20 minutes after the activity or when the pain increases. Nonsteroidal anti-inflammatory drugs (NSAIDs) can also be used. Stretch the calf. Increase calf flexibility with stretching for 30 to 45 seconds several times a day.
Protect the heel
It may be necessary to modify the footwear to provide the correct heel lift or arch support. If possible, select a shoe with good heel lift and a suitable arch support. Try heel lift stands or insoles on sports shoes, especially those with studs. Try an arch support on studded sports shoes if flat feet compound the problem.
Take one step at a time
Run again and resume impact activities gradually as symptoms allow. Sever’s disease usually disappears when the growth plate (epiphysis) matures, which happens at 12 or 13 years of age in girls and at 13 or 14 years in boys.