Sever's disease is a common cause of heel pain in active children. It is not dangerous, and will not cause long term problems as an adult.
It can however hurt into adulthood and can often restrict your child from participating in sport.
It commonly affects kids between the ages of 8 and 13 for girls and 10 and 15 for boys.
You may notice your child limping during walking or running, or they might complain of pain after walking or running.
The Achilles tendon is often tender when pressure is applied to it from the side.
Sever's disease is a common cause of heel pain in active children. It is medically known as osteochondritis of the calcaneal apophysis, but commonly referred to as Sever's. It is not dangerous, it is self-limiting, and will not cause long term problems as an adult.
It does however hurt up until the teenage years and can often restrict your child from participating in sport and age related social activities.
What causes Sever's disease?
Sever's disease is a common cause of heel pain in physically active growing children. It usually occurs during the growth spurt of adolescence; an approximate 2-year period in early puberty when kids grow most rapidly. This growth spurt can begin anytime between the ages of 8 and 13 for girls and 10 and 15 for boys.
The Achilles Tendon inserts at the top of the growth plate and the plantar fascia inserts at the bottom of the growth plate. As the bone grows quickly the calf muscle struggles to keep up with the growth and becomes tight pulling the Achilles tendon in an upward direction, causing pain. Underneath the foot the plantar fascia acts as a tie bar holding up the arch. If the foot rolls in too far, the plantar fascia stretches pulling the ligament in the opposite direction. This compresses the growth plate against the heel bone (calcaneus), causing pain.
What are Sever's disease symptoms?
As a parent, you may notice your child limping during walking or running, or they might complain of pain after walking or running. Pain is always produced when pressure is applied to the non-weight bearing medial/inside surface of the heel. The Achilles tendon is often tender when pressure is applied to it from the side.
What results can I expect after treatment?
When we reduce the stretch to the plantar fascia and Achilles tendon the pain immediately disappears.
What is patellofemoral pain syndrome?
Patellofemoral pain syndrome is the medical term for pain felt behind your kneecap, where your patella (kneecap) glides over your thigh bone (femur). This joint is known as your patellofemoral joint. Patellofemoral pain syndrome, is mainly due to excessive patellofemoral joint pressure from poor kneecap alignment, which in time can lead to arthritic joint surface changes on the under surface of the kneecap.
What causes patellofemoral pain syndrome?
Your patella normally glides up and down through the femoral groove. As your knee is bent, pressure between your kneecap and the groove increases. This retro patellar pressure is further increased if the patella does not ride normally through the groove, but “mistracks” - meaning it travels more to one side, making it rub against the femur. The mistraking or sliding of the patella to the outside of the knee is increased when the foot rolls in and the leg internally rotates.
How does Advanced Podiatry treat this condition?
Advanced Podiatry receives many referrals to work closely with physiotherapists and sports medicine specialists. Our treatment aims to stabilize the kneecap (patella) and to improve its glide path across the front of the knee (femur). We are often requested to assess the alignment the leg and the foot, and to treat with foot orthotics to improve the tracking or gliding of the kneecap.
If the foot is rolling in and is out of balance with the leg, the leg will internally rotate.
An Advanced Podiatrist is able to assess the amount of foot correction needed to balance alignment of the foot with the leg. With this knowledge a foot orthotic can be individually designed, or chosen off the shelf, which will externally rotate the leg and improve the glide and tracking of the knee cap.
What results can I expect after treatment?
Patello femoral (kneecap pain) cannot be treated in isolation with one type of treatment. When the combined treatment of physiotherapy, exercise and orthotics are introduced the results can be quick with pain free return to activity.
What Is Osgood Schlatter’s disease?
Osgood Schlatter's disease is inflammation of the bone at the top of the tibia (shin bone), where the tendon from the patella (kneecap) attaches. It is an overuse knee injury rather than a traumatic injury. Although it is relatively uncommon, it is quite a debilitating knee injury that occurs in young active children/adolescents.
A bump that develops below the knee is painful to press and to kneel on, and the patella tendon is also often tender to press. When x-rayed this bump is often looks like lifting of the growth plate on the front of the Tibia.
It is most commonly seen in children between the ages of 10 and 15, who are typically involved in sport and having a rapid growth spurt. Osgood Schlatter's is self-limiting, meaning that your child will grow out of it.
What causes Osgood Schlatter’s disease?
Excessive pronation (fattening or rolling in of the feet) - This causes an increase in internal leg rotation, an increase in leg rotation and a greater amount of shearing tension of the insertion of the patella tendon to the tibia.
Accelerated growth spurt with subsequent tightening and pulling of the patella tendon, and an imbalance of musculoskeletal strength and flexibility.
Frequent high impact sport including running, jumping, acceleration and direction change i.e. soccer, netball, cross country running.
How do you treat Osgood Schlatter’s disease?
Advanced Podiatry receives many referrals to work closely with physiotherapists and sports medicine specialists. We are often requested to provide preform or custom foot orthotics designed to reduce the rolling in of the foot (pronation) and to externally rotate the leg.
Achieving this better alignment will help the knee cap glide more straight up and down rather than being pulled to the side and inflaming the patella tendon and insertion.
We also discourage squatting and any movement that results in a painful reaction. Temporary rest from high impact activity may be necessary, to reduce it to a level that is comfortable. Graduated return to normal levels can then follow.
What are growing pains?
Growing pains are real, but are essentially harmless muscular pains, that can affect children between the ages of 3 and 5 years, and from 8 to 11 years. Boys and girls are equally affected.
Some young people may continue to experience growing pains into their early adolescence or teenage years. Pain may be experienced in the legs – often the calf, front of thigh or behind the knees – and is often worse in the afternoon or evening. Sometimes, the pain can wake a child from their sleep. The cause is not known.
Even though the child can be in a lot of pain, no damage is happening to the child's bones or muscles, and growing pains can respond to simple treatments.
What causes growing pains?
The cause of growing pains is unclear. The most popular belief is that during a growth spurt the muscles are being stretched and become tight during the bone/muscle length adaptation phase. Not all children experience growing pains. Those who do generally have these common factors: - They are physically very active and often participate in sport that involves running or jumping. - They have poor posture – standing, sitting or walking awkwardly. - The child has feet which roll in and not properly aligned with the legs. This puts greater strain on the supporting muscles of the body.
What are the symptoms of growing pains?
- Muscular aches and pains are felt in both legs – typically in the calf, behind the knee and in the front of the thigh. - Moving the legs does not make the pain better or worse, which shows that the joints are not affected. - The pain comes and goes, occurring every night for a week or so, or a few times a week, or may occur only occasionally. - The onset of pain is around the late afternoon or evening. - The pain is worse during the night, particularly when the child is supposed to be going to sleep. - The pain may be severe enough to wake the child from sleep. - The pain is gone by morning. - The pain doesn't cause a limp or make it hard to run and play normally. - Occasionally, the muscles of the arms may also be affected.
How do you diagnose growing pains?
Growing pains are diagnosed by ruling out all other causes of leg pain. Other health problems that can cause pain in the legs include arthritis – which damages joints, or infections (such as osteomyelitis) and some virus infections (such as Ross River virus).
Always see your doctor if your child has severe pain or pain that only affects one leg (or arm), if the pain is still there during the day, if the child is unwell or has a fever, loss of appetite or rashes, has swelling, reddening or tenderness of the leg or arm, or is limping.
How do you treat growing pains?
Always see your doctor to make sure that there is no other cause of pain. Once other causes of growing pains are ruled out Advanced Podiatry can design a successful treatment program which may include: - stretching and strengthening exercises - a footwear check to make sure the shoes are suitable for the activity they are being used - a foot and leg alignment check. Alignment changes could be contributing to muscle overload, and can be balanced with foot orthotics.
Home treatment: - plenty of cuddles and reassurance that the pain will go away and that their legs will feel normal by morning - massaging the painful area using special massage oils (this is not necessary to ease the pain, but may help your child feel special) - heat treatment, such as warm baths and heat packs - medicines that reduce pain, such as paracetamol (check the bottle to make sure that you give the right dose)
What results can I expect?
The good news is that growing pains do not last, do not cause long term problems and generally have an excellent outcome when we treat this condition at Advanced Podiatry.