Severs Disease Physical Therapy
Overview


Sever's disease, or calcaneal apophysitis, is a common cause of heel pain among active children between 10 to 13 years old. This spontaneous heel pain results from injury to the heel bone?s growth plate which is caused by overuse rather than specific injury or trauma. The condition is common among athletic children, particularly those active in soccer, football, and baseball. Treatment is available to reduce pain and discomfort associated with Sever's disease, but the condition usually resolves on its own once feet stop growing.


Causes


During the growth spurt of early puberty, the heel bone (also called the calcaneus) sometimes grows faster than the leg muscles and tendons. This can cause the muscles and tendons to become very tight and overstretched, making the heel less flexible and putting pressure on the growth plate. The Achilles tendon (also called the heel cord) is the strongest tendon that attaches to the growth plate in the heel. Over time, repeated stress (force or pressure) on the already tight Achilles tendon damages the growth plate, causing the swelling, tenderness, and pain of Sever's disease. Such stress commonly results from physical activities and sports that involve running and jumping, especially those that take place on hard surfaces, such as track, basketball, soccer, and gymnastics.


Symptoms


Sever?s is recognized by pain in the back and lower regions of the heel. It usually starts during or immediately following the child's growth spurt, and/or in very active individuals. The child will usually have pain during or following participation in sport, and will often be seen limping off the field or court. Symptoms of Sever's include painful heel, no swelling or warmth, night pain is absent, pain is worse with increased activity, pain which is usually relieved by rest. Children often hobble or limp from the sports field.


Diagnosis


To diagnose the cause of the child?s heel pain and rule out other more serious conditions, the foot and ankle surgeon obtains a thorough medical history and asks questions about recent activities. The surgeon will also examine the child?s foot and leg. X-rays are often used to evaluate the condition. Other advanced imaging studies and laboratory tests may also be ordered.


Non Surgical Treatment


Treatment is initially focused on reducing the present pain and limitations and then on preventing recurrence. Limitation of activity (especially running and jumping) usually is necessary. In Micheli and Ireland's study, 84% of 85 patients were able to resume sports activities after 2 months. If the symptoms are not severe enough to warrant limiting sports activities or if the patient and parents are unwilling to miss a critical portion of the sport season, wearing a half-inch inner-shoe heel lift (at all times during ambulation), a monitored stretching program, presport and postsport icing, and judicious use of anti-inflammatory agents normally reduce the symptoms and allow continued participation. If symptoms worsen, activity modification must be included. For severe cases, short-term (2-3 weeks) cast treatment in mild equinus can be used.


Exercise


Exercises that help to stretch the calf muscles and hamstrings are effective at treating Sever's disease. An exercise known as foot curling, in which the foot is pointed away from the body, then curled toward the body in order to help stretch the muscles, has also proven to be very effective at treating Sever's disease. The curling exercise should be done in sets of 10 or 20 repetitions, and repeated several times throughout the day.
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2017/07/20 (木) 11:56:48 | | #[ Edit ]
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