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.