If your child is experiencing activity related pain just below the kneecap, at the top of the shinbone, or in their heel or hip then the chances are they are suffering from Osgood Schlatter, Severs
disease or Ischial Apophysitis respectively. Today, thousands of children are diagnosed with one of these conditions every year. Many others are never diagnosed and the discomfort is often dismissed
as 'growing pains'
Sever's disease is a common cause of heel pain in physically active growing kids. It usually occurs during the growth spurt of adolescence, the approximately 2-year period in early puberty when kids
grow most rapidly. This growth spurt can begin anytime between the ages of 8 to 13 for girls and 10 to 15 for boys. Peak incidences are girls, 8 to 10 years old. Boys, 10 to 12 years old.
The patient complains of activity related pain that usually settles with rest. On Examination the heel bone - or calcaneum - is tender on one or both sides. The gastrocnemius and soleus muscles (calf
muscles) may be tight and bending of the ankle might be limited because of that. Foot pronation (rolling in) often exacerbates the problem. There is rarely anything to see and with no redness or
swelling and a pain that comes and goes mum and dad often wait before seeking advice on this condition. The pain may come on partway through a game and get worse or come at the end of the game.
Initially pain will be related only to activity but as it gets worse the soreness will still be there the next morning and the child might limp on first getting up.
Sever condition is diagnosed by detecting the characteristic symptoms and signs above in the older children, particularly boys between 8 and 15 years of age. Sometimes X-ray testing can be helpful as
it can occasionally demonstrate irregularity of the calcaneus bone at the point where the Achilles tendon attaches.
Non Surgical Treatment
Physiotherapy treatment to improve range of the ankle and descrease soft tissue tightness. Orthotics to control excessive motion of the foot. Icing the painful area. Use of topical anti-inflammatory
cream. Taping of the foot during exercise. Stretching, only if recommended by the physiotherapist.
For children with Sever's disease, it is important to habitually perform exercises to stretch the hamstrings, calf muscles, and the tendons on the back of the leg. Stretching should be performed 2-3
times a day. Each stretch should be performed for 20 seconds, and both legs should be stretched, even if the pain is only in one heel. Heel cups or an inner shoe heel lifts are often recommended for
patient suffering from Sever's disease. Wearing running shoes with built in heel cups can also decrease the symptoms because they can help soften the impact on the heel when walking, running, or