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Thursday, November 10, 2011

Sever's Disease: Growth Plate Injury in a Child's Heel



     The above photo is of the heel bone in a 12 year old boy. The heel bone is called the "calcaneus" and has an important growth plate at the base. Boys from 8 to 14 and Girls 7 to 13 can have pain develop in this area either from the pull of the achilles tendon, or the pull of the plantar fascia. After those ages, the growth plates fuse and there can no longer be a source of pain. With my 2 boys growing up, and playing tons of sports, both had this problem. Ice soaking (see separate post) for 20 minutes twice daily really minimizes the soreness, but you must start as soon as the soreness begins. At least they could just dip their heel into the ice water, not the entire foot. We always joked as they iced that they were now guaranteed to grow more.

     The basic rule is to create a pain free environment with no limping. Hopefully, they can continue playing, but the parents and coaches must watch for limping/favoring.  Electrical Stimulation with ice is a good physical therapy modality along with achilles stretching without pain. If you look closely at the photo, you can see how the achilles tendon attaches right on it, and can irritate it endlessly. Some form of heel cushion or lift, if it makes it feel better, is also helpful. 

     I will always remember Alex, short for his age at 10 years old, less than 5 foot tall,  and with one of the worse, long-lasting, stubborn cases I have treated. The symptoms remained significant for almost one year. When all was said and done, by 14 years old,  he was 6 feet 2 and still growing. 

2 comments:

  1. My son has suffered with this for about 1 year. He is nearly 11. Exactly as you described. He had x-rays today, compared them to this image. It is identical. Have you ever used medrol dose pack to relieve severe inflammation? He started that yesterday. A month of rest (no activity other than school), advil 400 mg 3X a day did not help alleviate pain. I am praying for some relief for him.

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    Replies
    1. Hey Dad, sorry to hear about your son. Definitely medrol dose pack is used at that age alot. Commmonly for asthma and poison oak, but severe inflammation of any cause it can sure do the trick. Give me a progress report after he goes through the medication. Once he is off the cortisone, he should go back to the Advil, ice for 20 minutes twice daily, and do contrast baths once daily. This attack on the inflammation should knock it out. The order of ending is 1) medrol dose pack, 2)advil, 3) contrasts, and then 4)icing. The medrol dose pack is a one time thing to knock down the inflammation, whereas the other 3 should be done until your son is back to full activity. I will try to be even clearer on my post today. Rich

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Thank you very much for leaving a comment. Due to my time restraints, some comments may not be answered.I will answer questions that I feel will help the community as a whole.. I can only answer medical questions in a general form. No specific answers can be given. Please consult a podiatrist, therapist, orthopedist, or sports medicine physician in your area for specific questions.