Foot & Ankle

Sever's Disease

Anatomy

Nearly one-fourth of all bones in the human body are in the feet. The foot is a complex, flexible structure that contains bones, joints, and more than 100 muscles, tendons and ligaments, all working together to enable movement and balance. The foot is divided into three sections:

• Forefoot—Has five toes (14 phalanges) and five longer bones (metatarsals). One phalanx of each of the five toes connects to one of the five metatarsals.
• Midfoot—Contains a pyramid-like group of bones, strengthened by tendons, muscles and ligaments to form three curves, or arches (medial, lateral and fundamental longitudinal), at the bottom of the foot. The midfoot includes three cuneiform bones, the cuboid bone, and the navicular bone on top of the midfoot.
• Hindfoot—Includes the heel (calcaneus), which is the largest bone in the foot and ankle. The ankle joint contains a small, irregular-shaped bone (talus) located between the heel, lower leg (fibula) and shinbone (tibia). The talus forms a connection between the leg and foot. The Achilles tendon connects the heel and calf muscle, allowing movement such as running, jumping, and standing on the toes.

Difficulties with foot position and function can lead to more serious problems, not only for the feet, but also for other areas, including the spine. In some cases, these problems may be caused by footwear that fits improperly, does not accommodate normal foot alignment, or that interferes with natural movement and balance of the body.

Description

Sever's disease (also known as osteochondrosis or apophysitis) is an inflammatory condition of the growth plate in the heel bone (calcaneus). One of most common causes of heel pain in children, Sever's Disease often occurs during adolescence when children hit a growth spurt.

Cause

Sever's disease is an overuse injury. As the foot strikes the ground during sports such as running, jumping or other activities, it produces repetitive stress on the growth plate that results in inflammation (swelling) and pain in the heel.

Nonsurgical Treatment

The primary treatment of Sever's disease is to rest the foot (stop the sport) until the pain goes away. Once the pain is gone, the child may return to normal activities. Additional treatments may include:

• Heel pads—Heel cushions inserted in sports shoes can help absorb impact and relieve stress on the heel and ankle.
• Stretching exercises—Stretches for the Achilles tendon (heel cord) can reduce stress on the heel.
• Nonsteroidal anti-inflammatory medication—Drugs like ibuprofen and naproxen reduce pain and swelling.
• Immobilization—In cases where the pain is bad enough to interfere with walking, a short-leg cast or "walker boot" might be required to immobilize the foot while it heals.

Recurrence

It is not unusual for Sever's disease to recur. This typically happens when a child increases sports activities. Wearing sports shoes that provide good support to the foot and heel may help prevent recurrence. Sever's disease will not return once a child is fully grown and the growth plate in the heel has hardened into bone.