Understanding Kids Heel Pain: Sever's Disease

Understanding Sever's Disease: A Guide for Parents and Young Athletes

Sever's Disease, also known as calcaneal apophysitis, is a common yet often misunderstood condition that affects children and adolescents, especially those engaged in sports. As a podiatrist, it's crucial to shed light on this condition, providing parents and young athletes with valuable information to better understand and manage Sever's Disease.

What is Sever's Disease?

Sever's Disease is not actually a disease but rather a growth plate disorder that occurs in the heel bone (calcaneus). It typically affects children and adolescents during periods of rapid growth, typically between the ages of 8 and 15, when the heel bone is still developing. The condition is most prevalent in young athletes involved in activities that put repetitive stress on the heel, such as running and jumping sports.

Causes:

1. Growth Plate Vulnerability: The growth plate in the heel is more susceptible to injury during periods of rapid bone growth.

2. Overuse and Repetitive Stress: Activities that involve repetitive impact on the heel, such as running or jumping, can contribute to irritation and inflammation in the growth plate.

3. Tight Achilles Tendon: A tight Achilles tendon can increase tension on the growth plate, exacerbating the condition.

Symptoms:

1. Heel Pain: The most common symptom is pain in the back or bottom of the heel, particularly during or after physical activity.

2. Limping or Walking on Toes: Children may alter their gait to avoid putting pressure on the affected heel.

3. Swelling and Redness: Inflammation in the heel area may lead to noticeable swelling and redness.

Treatment and Management:

1. Rest and Activity Modification: Temporary cessation or modification of activities that contribute to heel stress is essential to allow the growth plate to heal.

2. Ice Therapy: Applying ice to the affected area can help reduce inflammation and alleviate pain.

3. Stretching Exercises: Gentle stretching exercises for the Achilles tendon and calf muscles can alleviate tension on the growth plate.

4. Orthotic Support: Custom orthotic inserts can provide additional support and help address any biomechanical issues contributing to the condition.

5. Footwear: Choosing appropriate footwear with good cushioning and support is crucial in managing Sever's Disease.

Prevention:

1. Proper Warm-up and Stretching: Encourage young athletes to incorporate proper warm-up and stretching routines before engaging in sports activities.

2. Monitoring Growth Spurts: Regular check-ups with a podiatrist can help monitor a child's growth and address any potential issues early on.

3. Appropriate Footwear: Ensure that children wear properly fitted shoes suitable for their specific sport or activity.

Sever's Disease may be a common ailment in young athletes, but with proper understanding and proactive management, its impact can be minimized. As a podiatrist, educating parents, coaches, and young athletes about the condition is crucial for early detection and effective treatment, ultimately allowing children to continue enjoying their favorite sports with minimal disruption.

Helping Heel Pain

Are you suffering from debilitating heel pain? Don’t worry your Podiatrist can help.

Heel pain is a common concern for many individuals that can impact on your overall health and quality of life, which is why it is important to get a proper assessment and diagnosis. At Wentworth Falls Podiatry, our Podiatrists specialise in all things lower limb and can help you to get your feet back on track.

Who gets it?

Heel pain can affect individuals at any age and stages of life including children from 8-14, athletes, expectant mothers, workers on their feet all day such as tradies or nurses and even in our older age.

What causes heel pain?

There can be many causes of heel pain ranging from soft tissue concerns to structural abnormalities. When there is an increased amount of force placed upon the muscles and tendons in the feet and lower limb, pain and inflammation can occur. Additional complications can include strains and sprains to tendons and ligaments as well as trauma to the bones and fat pads along the bottom of the foot. Identifying the cause of the pain and reducing the physical load on the structures in the foot is your best defence for heel pain.

What treatment options are available?

Your Podiatrist can offer a wide range of treatments to best address your presenting heel pain problem. These treatments include but are not limited to; Shockwave therapy, dry needling, strapping or offloading, footwear recommendations, custom foot orthotics and specific exercise prescription for strength and flexibility.

Preventing future problems.

After your Podiatrist has identified the root cause of the problem, treatment and prevention strategies can be put in place to prevent re-occurrence in the future. Rest and cushioned devices can only take you so far to manage pain levels, a tailored rehabilitation program will best assist you on your way to recovery.

Heel pain! Here is 10 quick things you should know.

1.       The most common cause of heel pain is plantar fasciitis which is caused by excess strain to the thick connective tissue band along the bottom of the foot. Onset can be gradual, after trauma or from a sudden increase in activity.

2.       Not all heel pain is plantar fasciitis, other causes can be; abductor hallucis tendinopathy, Baxters nerve entrapment, stress fractures, fat pad atrophy or displacement, severs disease and more. Podiatrists are foot and ankle specialists that can help to properly assess, diagnose and treat your heel pain.

3.       Flat feet are not the only ones to get heel pain or plantar fasciitis. This can occur for high arched feet and neutral feet as well.

4.       ‘Custom’ foot orthotics are not all the same. Simple arch supports do not work for the long run and depending on your foot problem, certain types of orthotics or offloading devices may be required. Podiatrists at Wentworth Falls Podiatry can scan your foot appropriately to customise your treatment and devices. After seeing 1000`s of heel pain cases over the years we have been able to develop a range of orthotics that are accurate and effective as well as comfortable.

5.       Footwear, what is best? Avoid footwear that is too flat, too high and too cushioned. Your podiatrist can assist you with choosing the right shoe for your foot to decrease pain and prevent future complications as well as specific requirements for your workplace.

6.       Injections. This treatment option will only alleviate your symptoms not treat the underlying cause. Often relief will only last for a short duration before pain returns, which can be worse than the original pain. This is as a result of continuing to walk on the damaged structure during your ‘pain free period’. Multiple corticosteroid injection can additionally weaken the ligament it is applied, to leading to a potential future rupture.

7.       Compression is your friend. Due to the presence of inflammation most often associated with heel pain, Podiatry directed compression therapy can assist with pain relief and treatment. It helps to control the excess oedema that occurs from the body’s inflammatory response to healing.

8.       Rest and activity. A great way to improve your fitness and decrease unwanted weight gain is to get up and walk or run. Heel pain can be a major deterrent from participating in exercise and can also be a problem that has occurred from beginning a new exercise program. Rest can help with the early onset of pain however getting the right treatment as early as possible is important to maintaining a healthy lifestyle.

9.       Heel spurs! Often associated with chronic heel pain however can also present in individuals with no associated pain. A heel spur occurs in response to stress and strain on the soft tissue structures in the foot or in relation to a biomechanical imbalance.

10.   Heel pain is curable and your podiatrist at Wentworth falls Podiatry can help, book an appointment today.

Managing Midfoot Arthritis

Is pain in the mid-section of your foot giving you grief? It could be a sign of changes in your joints.

Where is the “midfoot”?

The midfoot is the middle region of the foot, where a cluster of bones form the arch on the top of the foot.

This cluster of bones (the cuboid, navicular and cuneiform bones) form the midtarsal joint (Chopart joint) and tarsometatarsal joints (TMTJs).

Role of the Midfoot:

1. Provide stability

2. Transmit and attenuate force when walking

3. Allow the foot to accommodate to uneven surfaces

Causes of Midfoot Arthritis

• Primary osteoarthritis with articular cartilage damage. Poor biomechanics and flattening of your arch can further worsen the pain.

• Secondary osteoarthritis – related to previous trauma to the joint such as a fracture or dislocation – even if well managed initially.

• Inflammatory conditions such as rheumatoid arthritis or psoriatic arthritis.

Treatment of Midfoot Arthritis

• Pain medication – topical or oral anti-inflammatories

• Custom orthotics are important:

  • Medial arch support reduces joint movement during weight bearing

  • A stiffer soled shoe + arch support further limits overloading

  • Shoe modification with a rocker bottom shoe transmits force efficiently through the joints

• Ultrasound guided steroid injections can be useful when isolated joints are affected

• Surgical intervention:

  • When non-operative treatment fails

Helping your feet this winter

CHILLBLAINS

Winter can be a challenging time to look after your feet. As the temperature drops, you may find the condition of your feet changing too. 

One of the most common skin issues in winter that we see are chilblains.  

A chilblain is a skin sore that occurs after exposure to very cold temperatures. They are patches of discoloured (red, blue, white), swollen, painful and sometimes itchy skin. 

Our feet are very susceptible to becoming TOO cold compared to the rest of our body. They are quite far from the heart and the blood vessels are very small. 

When our feet get cold, many people want to warm them up quickly. Putting your feet in front of the heater, fire, on a hot water bottle or electric blanket to warm up cold feet causes an intense and sudden opening and bursting of the blood vessels, resulting in a chilblain.  

Treating Chilblains 

• Chilblains often improve on their own after 1-2 weeks. 

• It can help to use a soothing lotion to relieve the itching such as calamine or witch hazel. 

• Lanolin or similar rubbed into the feet will help retain body heat. 

• Wear thick woollen socks. 

• Gentle exercise can help improve the circulation to your feet. 

Preventing Chilblains 

• Avoid sudden changes in the temperature of your feet 

• Wear lots of layers to retain heat 

• Avoid close or direct contact of feet with heaters, electric blankets, hot water etc. 

• Ensure your shoes are well fitting and comfortable  

• See a podiatrist for regular professional treatments. 

Severe, ulcerating, infected or recurring chilblains need professional attention. A qualified podiatrist can treat your chilblains and offer advice on prevention.