Definition

Pain in one or both heels upon walking or standing caused by a disturbance or interruption to the growth plates at the back of the heel bone - calcaneus.

Symptoms

Pain in one or both heels upon walking or standing and can occur after general activities such as running, jumping or sporting activities such as netball, basketball and football.  Symptoms include extreme pain when placing heel on the ground which is alleviated when the child walks on their toes.

The condition affects children usually between the ages 8-13 years.

Biomechanical Aetiology

Between the ages of 8-13 years children's bones are still in the growth stage and the growth plates have not become ossified.  The combination of growth, bad biomechanical structure and activity, such as sport, combine together to cause inflammation and pain at the point where the tendo Achilles (heel cord) inserts on to the calcaneus or heel bone.  Excessive pronation is a major contributing factor together with the child's growth spurt pattern.

Severs is similar to Osgood Schlatters disease of the knee, which usually occurs in slightly older children, both conditions respond exceptionally well to orthotic therapy.  Often the calcaneus (heel bone) can be dislocated and this may contribute to lowering the arch height and allowing the heel to increase its pronatory path stretching the Achilles and causing further pain and discomfort.

In very severe cases the growth plate can be detached from the calcaneus and fractures or microfractures can completely detach the plate and the growth plate can be pulled out of position up the heel as the Achilles tries to reposition the attachment to provide less tension.  If detachment occurs during this period bone death or necrosis can occur which can be quite dangerous to the child and affect their long term health and leisure activities.

Treatment

General treatment is rest, however telling high level child sports people to take complete rest is difficult and does not treat the condition proactively.

The use of ICB Orthotic Therapy is an excellent regime as they will realign the biomechanical structure and control the excess pronation of the foot and thereby stabilising the heel bone and its growth plate.

Mobilisation and adjustments of the foot should be undertaken after assessment to realign and reposition the joints.

Contraindication:

Patients exhibiting detachment of the growth plate should be referred to their local GP for referral to an orthopaedic specialist for either plaster procedure or possible surgical intervention.

Exercises

• Deep tissue massage of the calf muscles however, DO NOT STRETCH muscles as this may cause additional tearing of the attachment.