WHEN we use the term “growing pains” in children, Sever’s disease, otherwise known as calcaneal apophysitis, falls into this group.

It is a common foot disorder found in children and, though it can be very painful for the child, it is a temporary condition that has no long-term effects.

During puberty the heel bone sometimes grows quicker than the leg muscles and tendons. This causes tightness and stretching, which in turn puts pressure on the growth plates at the back of the heel. Patients will have inflammation and pain in this area.

Sever’s disease is most common in children between the ages of eight and 15, and seen usually in boys. It tends to occur more in those who are physically active and enjoy sports such as track, basketball, football, and gymnastics.

Children who stand for long periods of time and wear ill-fitting shoes are also more likely to develop it. Medical conditions that can exacerbate Sever’s disease are:

• Flat feet;

•Highly arched feet;

• Leg length discrepancy (one leg longer than the other);

• Pronated feet (a foot that roles in at the ankle);

• Obesity.

Symptoms of sever’s disease include:

• Pain in one or both heels, usually towards the back, that is worse on weight-bearing or during exercise;

• Swelling and redness;

• Morning stiffness in the feet;

• Limping.

Diagnosis

From the symptoms and activity level of the child, the doctor should be able to give a fairly accurate diagnosis.

The “squeeze test” at the back of the heel will also help to confirm the diagnosis. X-rays are usually not a very helpful tool in diagnosing sever’s disease but they can help to rule out other conditions like a fracture.

Treatment

Patients will fully recover from sever’s disease when the bone has fully developed. It is not known to cause any long-term disability and the symptoms, when treated, should subside within two to three weeks, at which time the child should be able to resume normal activities.

The main goal of treatment is to reduce the pain. It is advised that:

• The child reduces all physical activities and weight-bearing on the affected foot until the symptoms have gone. Activities like swimming and cycling may be okay as they do not put pressure on the heel.

• The patient adheres to RICE ( rest, ice, compress, elevate)

• orthotic devices be considered. Supportive appropriate footwear, preferably with the heel exposed, should be worn.

• Anti-inflammatory medication be prescribed;

• physiotherapy be considered;

• If the child is obese, a sensible weight loss programme should be maintained.

• the pronation or any other foot deformity that may exacerbate the condition be treated.

Angela Davis BSc (Hons) DPodM MChS is a podiatrist with offices in Montego Bay (293- 7119), Mandeville (962-2100), Ocho Rios (974-6339), Kingston (978-8392), and Savanna-la-Mar (955-3154). She is a member of the Health and Care Professions Council in the United Kingdom.